Hyperosmolar Nonketotic Coma

Patients with type 2 diabetes mellitus can develop a life-threatening condition called hyperosmolar nonketotic coma. It is caused by a profound increase in blood sugar levels. Doctors use the term hyperosmolar because the blood has too much sugar and salt in it. Nonketotic means that there are no ketones in the blood or urine. Hyperosmolar nonketotic coma occurs when a patient with type 2 diabetes:

• Stops taking their medications.
• Has an infection or other illness.
• Becomes dehydrated when the water content of the blood decreases.

When the condition is very severe, and before patients lose consciousness, they may experience:

• Increased urination
• Thirst and drinking more than usual
• Dizziness and fatigue
• Dark-brown urine 

The patient needs to be treated with fluids, electrolytes, and insulin in the emergency department.

Diabetic Ketoacidosis

Diabetic ketoacidosis is a life-threatening complication of type 1 diabetes mellitus in patients with very high blood sugar concentrations and ketones. Type 1 diabetics are unable to produce insulin, so the blood sugar can get higher and higher if not given insulin. Ketones build up in the blood because the cells cannot use the glucose from the bloodstream without insulin and resort to breaking down fats for energy. Ketones are harmful chemicals that are the by-products of fat metabolism.

Ketone Test

Related Whiteboard: What is Diabetic Ketoacidosis (DKA)?

People with diabetic ketoacidosis:

• Feel very thirsty and want to drink a lot. 
• Urinate larger amounts and more frequently. 
• Typically experience nausea, vomiting, and abdominal pain.
• Complain of exhaustion and have difficulty thinking.
• Have sweet-smelling, fruity breath from the ketones.

Patients with diabetic ketoacidosis need to be treated in the emergency department with fluids, electrolytes, and insulin.

First Aid Interventions in Hyperglycemia

Instructions for the first aid responder who encounters a hyperglycemic patient are as follows: 

1. Perform the primary and secondary assessments.
2. Attempt to determine if the person has type 1 or 2 diabetes mellitus. 
3. Immediately call 9-1-1. 
4. Ensure that the patient is breathing regularly and has a pulse. 
5. If the patient loses consciousness, perform the BLS assessment. 
6. If at any time the patient has irregular breathing or absent breathing without a pulse, immediately perform high-quality CPR.