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Non-ketotic hyperosmolar state (NKHS)



It is a serious condition most frequently seen in older persons with T2DM.

Risk Factors

Signs and symptoms

Diagnostic criteria

• Polyuria
• Ortostatic hypotension
• Altered mental state lethargy, obtundation, confusion
• Seizures, possible coma
• Diminished oral intake of fluids
• Profound dehydration
• Hypotension
• Tachycardia
• Weight loss

Differentiated from DKA by no nausea and vomiting, no abdominal pain, and no Kussmaul breathing

Note: Try to identify precipitating factors:

• Poor oral fluid intake
• MI, stroke, sepsis, pneumonia and other serious infections
• Medicines: thiazides diuretic, glucocorticoids, phenytoin


• Blood glucose
• Serum electrolytes (K+, Na+, Cl–)
• Initial serum K+ may be falsely high due to extracellular shifts.
• Renal function (Urea and Creatinine)
• Serum osmolarity (usually >330 mosmol/L)

o Serum osmolarity = 2(Na++ K+) + glucose + Urea (Glucose and Urea in mmol/L)
o Normal is < 310 mosmol/L as calculated


• A patient may be acidotic due to lactic acidosis or shock/sepsis:
• in this case principle management as in case of DKA
• IV fluids should be replaced as half-normal saline (0.45%) if hypernatremia, normal saline if serum sodium is normal
• There is frequently intercurrent illness usually sepsis, CVA, or cardiac and these must be diagnosed and treated.


  • Non-pharmacological

  • Pharmacological


Updated on,

23 Novemba 2020 12:33:19


1. STG

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