Hyperosmolar Hyperglycemic Nonketotic Coma

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Does protein metabolism occur in HHNK? If so, does the increase in urea due to protein metabolism or dehydration? Thanks.

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Does protein metabolism occur in HHNK?

In theory, very little protein breakdown and utilization occurs in Coma's accompanied by hyperglycemia. This is evidenced by the body's inability to utilize simple molecular chains like glucose.

If so, is the increase in urea due to protein metabolism or dehydration?

Increased urea can result from dehydration. Again we are dealing with multiple variables. As you know it is thought that increased urea levels are caused by renal failure, which is sometimes accompanied by the failure of other organs (including the brain).

I'm sure that you are considering their hydration status, cardiopulmonary state, liver/kidney/GI function, neurosis, pain, and behavioral state.

You have ruled out coagulopathies and genetic anomolies particularly structural.

best of luck and intelligence.

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Hey Y'all

I think I know what puzzles Debbi. In something so much like DKA, how come there's no Ketones which are the indicator of protein breakdown. Well, I'm just fishing around the ol' memory banks (which gets more and more risky as I grow older) but I seem to recall that the HHNC patient is typically a type II diabetic. In fact, I recall 'learning' in a class sometime that it is how some people learn they're diabetic. And the explanation was that a bare minimum of endogenous insulin exists that allow the cells to maintain glucose metabolism--so no ketones. And the remarkable urine output (driven by the amazing high glucose level-- > 1000) explain the high BUN/Creatinine.

I didn't look that one up, which I guess I ought to have done. But I think it's the answer you're looking for.

Papaw John

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Ketones which are the indicator of protein breakdown.

Thanks for your input Papaw John. I have just one comment regarding the quote above. Ketones are from lipolysis (adipose tissue), not proteolysis.

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In theory, very little protein breakdown and utilization occurs in Coma's accompanied by hyperglycemia. This is evidenced by the body's inability to utilize simple molecular chains like glucose.

Thanks for your reply Eric, after doing some research around the net and journals, I came across this http://pmj.bmjjournals.com/content/vol80/issue943/images/large/pj4291.f1.jpeg

Protein metabolism does happen in HHNK due to cortisol, hence the release of glucocorticoids which promote protein metabolism. I think thats correct.:coollook:

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:scrm::thnkg::sstrs:

OK I am puzzled and I need some help. Is HHNK, HHNC, HHNS all the same thing? Have been studying diabetes for NCLEX

HHNK = hyperosmolar hyperglycemic nonketosis

HHNC = hyperosmolar hyperglycemic nonketosis coma

HHNS = hyperosmolar hyperglycemic nonketotic syndrome

If the same is ok but if not, how are they treated differently for purposes of NCLEX?

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Specializes in CTICU.

I would think HHNK and HHNS are the same thing - a cluster of symptoms with a common etiology, while HHNC is when the patient enters a coma due to it.

But it may all the the same thing. Sounds fairly common sense in any case - NCLEX would not ask you to differentiate between names, but would provide the scenario and ask you to analyze the cause/contributing factors etc.

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