What is a Hyperosmolar Coma?

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  • Written By: J.M. Willhite
  • Edited By: Heather Bailey
  • Last Modified Date: 22 November 2018
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A hyperosmolar coma, also known as a hyperosmolar nonketotic coma (HONK), is a serious complication associated with type 2 diabetes. Resulting from the development of hyperosmolarity, or extremely high blood glucose levels, there are a number of risk factors associated with the development of this condition. Treatment may include the intravenous administration of insulin and fluids. As with any serious medical condition, there are risks associated with HONK and individuals who become symptomatic should immediately seek medical attention to prevent further complication.

Commonly found among individuals with a diagnosis of type 2 diabetes, HONK is a condition that may also affect individuals who have been unsuccessful in regulating their blood sugar levels or do not know they are diabetic. Serious illness or the presence of infection may trigger the development of a hyperosmolar coma. HONK is a condition comprised of multiple factors including extreme dehydration, excessively high blood glucose levels, and impaired consciousness.

Individuals who stay hydrated maintain steady glucose levels of the blood. The kidneys act as a filter to rid the body of excess glucose, however, when an individual decreases his or her fluid intake the amount of glucose filtered from the body likewise decreases. Additionally, the consumption of sugary beverages by those who have existing high glucose levels may also result in impaired kidney function. The unfiltered glucose builds and, ultimately, results in a condition known as hyperosmolarity.


The blood of those who develop hyperosmolarity possesses excessively high levels of salt, sugar, and other substances which impact water levels in the body. The organs and tissues of the body need a continuous supply of water in order to function properly. When water intake is decreased, the body pulls water from various tissues and organs to maintain balance and functionality. The resulting situation of increasing blood sugar levels and decreasing availability of water contributes to hyperosmolarity.

Individuals at greatest risk for hyperosmolarity are those who have recently experienced a heart attack or stroke. Those of advanced age or who have been diagnosed with impaired kidney function are also at increased risk. Additional risk factors include an inability to properly manage one’s diabetes, a discontinuation of diabetic medication, and congestive heart failure.

Those who experience confusion, nausea, or weakness may be symptomatic of having hyperosmolarity. Symptoms which develop during the early onset of hyperosmolarity progressively worsen with time. Individuals exhibiting impaired speech or numbness in their limbs may be experiencing dangerously high blood glucose levels associated with the development of a hyperosmolar coma.

A variety of blood tests are generally administered to confirm a diagnosis of this condition. The individual may undergo a urinalysis to evaluate the presence of compounds and determine the dilution versus concentration of the urine. In cases where the individual is recommended for further evaluation, an electrocardiogram (ECG) and chest X-ray may be performed to assess the condition and functionality of his or her heart.

Treatment for hyperosmolar coma may include the administration of intravenous insulin to stabilize the individual’s blood glucose levels. Potassium and fluids are given intravenously to restore hydration and electrolytes. The mortality rate associated with this condition is relatively high since most individuals who develop it have a pre-existing condition. Complications associated with HONK include blood clots, shock, and swelling of the brain, known as cerebral edema. Individuals with type 2 diabetes can prevent the onset of hyperosmolarity and hyperosmolar coma by understanding the warning signs of dehydration and taking the appropriate steps to rehydrate.


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Post 1

I didn't know there was a connection between dehydration and blood sugar levels. What the article says in the third paragraph about people who stay hydrated maintaining steady glucose levels in the blood makes sense.

This also concerns me a little because I have a tough time staying hydrated when I exercise and play sports. I sweat a lot and can't seem to drink as much liquid as I sweat out. However, reading this article gives me even more motivation to keep downing the fluids.

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