Hyperosmolar Hyperglycemic Nonketotic Coma in Neurosurgery:Report of Six HHNC

ABSTRACT

In 1957 Sament and Schwartz reported patient with profound coma and hyperglycemia but without ketonemia or acidosis. This syndrome in usually termed hyperosmolar hyperglycemic nonketotic coma(HHNC). Six critically ill patients while on the neurosurgical service were studied to establish the diagnosis of HHNC. Criteria for the diagnosis of HHNC included. 1) Serum glucose over than 220 mg/dl wigh glucosuria. 2) absence of significant acetonuria. 3) serum Na over than 150 mEq/l. 4) serum osmolarity over than 310 mOsM/kg. 5) neurological dysfunction. The production of the characteristic stupor and diminution of mental acuity appears to result from a decrease in intracellular water content within the brain due to the osmotic effects of those predominately extracellular substances. Factors documented to be significant in it's development include nonspecific stress to primary illness, hyperosmolar tube feeding. Dehydration, and mannitol, dilantin and steroid administration. The treatment of HHNC recommended the division of replacement into two stages 1) rapid repair of water deficits which was calculated by described formula and correct the Na abnormality. 2) insulin replacement according to the degree of glucosuria. During the replacement therapy of water deficit and insulin, it should be necessary to repeat plasma electrolytes and blood glucose at 4 hour intervals until normal levels are approached. One among the 6 cases of HHNC became good recovery and 5 cases were expired on treatment, Fatal complications of this syndrome, such as acute renal failure, terminal arrhythmias and cardiopulmonary dysfunction, both cerebral and systemic, were common in these cases.