Hyperglycemic Hyperosmolar Nonketotic Coma (HHNK)

  1. General information
    1. Complication of diabetes, characterized by hyperglycemia and a hyperosmolar state without ketosis
    2. Occurs in non-insulin-dependent diabetics or nondiabetic persons (typically elderly clients)
    3. Precipitating factors: undiagnosed diabetes; infections or other stress; certain medications (e.g., Dilantin, thiazide diuretics); dialysis; hyperalimentation; major burns; pancreatic disease
  2. Assessment findings
    1. Similar to ketoacidosis but without Kussmaul respirations and acetone breath
    2. Laboratory tests
      1. Blood glucose level extremely elevated
      2. BUN, creatine, hct elevated (due to dehydration)
      3. Urine positive for glucose
  3. Nursing interventions: treatment and nursing care is similar to DKA, excluding measures to treat ketosis and metabolic acidosis.