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1

Filbin, Michael R., David F. M. Brown, and Eric S. Nadel. "Hyperglycemic hyperosmolar nonketotic coma." Journal of Emergency Medicine 20, no. 3 (2001): 285–90. http://dx.doi.org/10.1016/s0736-4679(01)00283-9.

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2

Pope, Dana W., and David Dansky. "Hyperosmolar Hyperglycemic Nonketotic Coma." Emergency Medicine Clinics of North America 7, no. 4 (1989): 849–57. http://dx.doi.org/10.1016/s0733-8627(20)30320-5.

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3

Kitabchi, Abbas E., and Mary Beth Murphy. "Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic Nonketotic Coma." Medical Clinics of North America 72, no. 6 (1988): 1545–63. http://dx.doi.org/10.1016/s0025-7125(16)30721-0.

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4

Graves, Leland. "Diabetic ketoacidosi and hyperosmolar hyperglycemic nonketotic coma." Critical Care Nursing Quarterly 13, no. 3 (1990): 50–61. http://dx.doi.org/10.1097/00002727-199011000-00009.

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5

Leske, JS. "Hyperglycemic hyperosmolar nonketotic coma: a nursing care plan." Critical Care Nurse 5, no. 5 (1985): 49–56. http://dx.doi.org/10.4037/ccn1985.5.5.49.

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6

Amundson, Capt Dennis E., CDR John C. Olsen, and CDR David S. Wade. "Partial central diabetes insipidus complicating nonketotic hyperglycemic hyperosmolar coma." Journal of the American Osteopathic Association 96, no. 10 (1996): 603. http://dx.doi.org/10.7556/jaoa.1996.96.10.603.

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7

Nakano, Toru, Go Miyata, Ko Onodera, et al. "Hyperosmolar hyperglycemic nonketotic coma after chemoradiotherapy for esophageal cancer." Esophagus 11, no. 4 (2013): 273–76. http://dx.doi.org/10.1007/s10388-013-0405-5.

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8

SHIMODA, Masami, Shinya YAMADA, Masaki SHINODA, et al. "Low-dose Dopamine Treatment of Patients in Nonketotic Hyperosmolar Hyperglycemic Coma." Neurologia medico-chirurgica 29, no. 10 (1989): 890–94. http://dx.doi.org/10.2176/nmc.29.890.

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9

Campanella, Lisa Marie, Richard Lartey, and Richard Shih. "Severe Hyperglycemic Hyperosmolar Nonketotic Coma in a Nondiabetic Patient Receiving Aripiprazole." Annals of Emergency Medicine 53, no. 2 (2009): 264–66. http://dx.doi.org/10.1016/j.annemergmed.2008.04.002.

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10

Seki, Shuji. "Clinical features of hyperosmolar hyperglycemic nonketotic diabetic coma associated with cardiac operations." Journal of Thoracic and Cardiovascular Surgery 91, no. 6 (1986): 867–73. http://dx.doi.org/10.1016/s0022-5223(19)35965-3.

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11

Ellis, Eileen N. "Concepts of Fluid Therapy in Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic Nonketotic Coma." Pediatric Clinics of North America 37, no. 2 (1990): 313–21. http://dx.doi.org/10.1016/s0031-3955(16)36870-5.

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12

SEKI, S. "Clinical Features of Hyperosmolar Hyperglycemic Nonketotic Diabetic Coma Associated with Cardiac Operations." Survey of Anesthesiology 31, no. 1 (1987): 2. http://dx.doi.org/10.1097/00132586-198702000-00002.

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13

GOTTSCHALK, MICHAEL E., SIMON P. ROS, and W. PATRICK ZELLER. "The emergency management of hyperglycemic-hyperosmolar nonketotic coma in the pediatric patient." Pediatric Emergency Care 12, no. 1 (1996): 48–51. http://dx.doi.org/10.1097/00006565-199602000-00014.

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14

Khan, Ihsan, Viswanath Vasudevan, Farhad Arjomand, Rana Ali, and Saleem Shahzad. "Quetiapine Induced Fatal Neuroleptic Malignant Syndrome(NMS) and Hyperosmolar Hyperglycemic Nonketotic Coma (HHNC)." Chest 140, no. 4 (2011): 113A. http://dx.doi.org/10.1378/chest.1114380.

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15

Murao, Yoshinori, Seiji Miyamoto, Yoshimasa Nosaka, et al. "Hyperosmolar Hyperglycemic Nonketotic Coma (HHNC) Accompanied with Acute Renal Failure, Rhabdomyolysis and Acute Obstructive Hydrocephalus." Nihon Kyukyu Igakukai Zasshi 11, no. 4 (2000): 179–85. http://dx.doi.org/10.3893/jjaam.11.179.

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16

Singh, Balraj, Parminder Kaur, Nicole Majachani, Prem Patel, Ro-Jay Romor Reid, and Michael Maroules. "COVID-19 and Combined Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar Nonketotic Coma: Report of 11 Cases." Journal of Investigative Medicine High Impact Case Reports 9 (January 2021): 232470962110212. http://dx.doi.org/10.1177/23247096211021231.

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We report 11 cases of combined diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar nonketotic coma (HHNK) in coronavirus 2019 patients who presented to our institution in New Jersey, USA. The median age was 47 years (range 12-88 years). Out of the 11 patients, 7 were male and 4 were female. Out of 11 patients, 8 had type 2 diabetes mellitus (DM), 2 had undiagnosed DM, and 1 had type 1 DM. Presenting complaints included altered mental status, weakness, shortness of breath, cough, fever, vomiting, abdominal pain, chest pain, and foot pain. Out of 11 patients, pneumonia was diagnosed at pr
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17

Magner, P. O., and M. L. Halperin. "Effect of metabolic acidosis on glucose reabsorption in rats with acute hyperglycemia." Canadian Journal of Physiology and Pharmacology 68, no. 1 (1990): 79–83. http://dx.doi.org/10.1139/y90-011.

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The rate of reabsorption of glucose in the kidney is a factor to consider with respect to the degree of hyperglycemia in poorly controlled diabetics. The rate of reabsorption of glucose in the proximal tubule is driven by the electrochemical gradient for sodium across the luminal membrane. This gradient in the proximal tubule is also used to reabsorb a number of other substances, quantitatively the most important being bicarbonate. We wished to explore the hypothesis that acidosis, by reducing the filtered load of bicarbonate and therefore the reabsorption of bicarbonate in the proximal tubule
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18

G, Sruthi, Haritha H. Pillai, Nisha Ullas, Jiju V, and Elessy Abraham. "Role of Antioxidants in the Management Diabetes Mellitus." International Journal of Pharmaceutical Sciences and Nanotechnology 10, no. 4 (2017): 3763–67. http://dx.doi.org/10.37285/ijpsn.2017.10.4.2.

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Diabetes mellitus (DM), commonly referred to as diabetes, is a group of metabolic diseases in which there are high blood sugar levels over a prolonged period. Symptoms of high blood sugar include frequent urination, increased thirst and increased hunger. If left untreated, diabetes can cause many complications. Acute complications can include diabetic ketoacidosis, nonketotic hyperosmolar coma, or death. Serious long-term complications include heart disease, stroke, chronic kidney failure, foot ulcers, and damage to the eyes. Oxidative stress plays a major role in the pathogenesis and developm
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19

YODONAWA, Masahiko, Kazuyuki KOHNO, and Sohkichi TANAKA. "Hyperosmolar Nonketotic Coma." Neurologia medico-chirurgica 26, no. 4 (1986): 328–32. http://dx.doi.org/10.2176/nmc.26.328.

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20

Hughes-Davies, T. H. "Hyperosmolar nonketotic coma." Practical Diabetes International 2, no. 5 (1985): 56. http://dx.doi.org/10.1002/pdi.1960020521.

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21

O'Hanlon-Nichols, Theresa. "Hyperglycemic Hyperosmolar Nonketotic Syndrome." American Journal of Nursing 96, no. 3 (1996): 38–39. http://dx.doi.org/10.1097/00000446-199603000-00019.

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22

Venkatraman, R., and Sunit C. Singhi. "Hyperglycemic hyperosmolar nonketotic syndrome." Indian Journal of Pediatrics 73, no. 1 (2006): 55–60. http://dx.doi.org/10.1007/bf02758261.

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23

Shuster, Joel. "Trimethoprim/Sulfamethoxazole-Induced Higher-Level Gait Disorder Aggrenox-Induced Stevens-Johnson Syndrome Serum Sickness–Like Reaction to Efalizumab Fluoroquinolone-Associated Achilles Tendinitis Severe Hyperglycemic, Hyperosmolar, Nonketotic Coma in a Patient Without Diabetes Receiving Aripiprazole Antidepressant-Induced Nightmares." Hospital Pharmacy 44, no. 5 (2009): 379–82. http://dx.doi.org/10.1310/hpj4405-379.

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The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), discuss methods of prevention, and promote reporting of ADRs to the US Food and Drug Administration's (FDA's) MedWatch program (800-FDA-1088). If you have reported an interesting, preventable ADR to MedWatch, please consider sharing the account with our readers.
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24

HARDMAN, LISA, and FRAN TOPPINGS YOUNG. "Combating hyperosmolar hyperglycemic nonketotic syndrome." Nursing 31, no. 3 (2001): 32hn1–32hn4. http://dx.doi.org/10.1097/00152193-200131030-00010.

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25

Noda, S., A. Takao, H. Itoh, and H. Umezaki. "Opsoclonus in hyperosmolar nonketotic coma." Journal of Neurology, Neurosurgery & Psychiatry 48, no. 11 (1985): 1186–87. http://dx.doi.org/10.1136/jnnp.48.11.1186.

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26

O'Hanlon-Nichols, Theresa. "Clinical Snapshot: Hyperglycemic Hyperosmolar Nonketotic Syndrome." American Journal of Nursing 96, no. 3 (1996): 38. http://dx.doi.org/10.2307/3465159.

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27

Yeddi, Ahmed, Pranav Shah, Omnia Awad, Mohamed A. Abdallah, and Ijeoma Nnodim. "Acetazolamide-Associated Hyperosmolar Hyperglycemic Nonketotic Syndrome." American Journal of Therapeutics 27, no. 6 (2020): e690-e692. http://dx.doi.org/10.1097/mjt.0000000000001050.

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28

Lovera González, Pablo Danielo, Rodrigo José Sánchez, Emilio Hugo Torres Sosa, Cristian Rodrigo Matto Sanchez, Cecilia Isabel Par, and Albert Rafael Barrail Hellman. "Hemiballism in nonketotic hyperosmolar hyperglycemic syndrome." Revista Virtual de la Sociedad Paraguaya de Medicina Interna 8, no. 1 (2021): 173–77. http://dx.doi.org/10.18004/rvspmi/2312-3893/2021.08.01.173.

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29

Schlepphorst, E., and M. E. Levin. "Rhabdomyolysis Associated with Hyperosmolar Nonketotic Coma." Diabetes Care 8, no. 2 (1985): 198–200. http://dx.doi.org/10.2337/diacare.8.2.198.

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30

Delaney, Miriam F., Ariel Zisman, and William M. Kettyle. "DIABETIC KETOACIDOSIS AND HYPERGLYCEMIC HYPEROSMOLAR NONKETOTIC SYNDROME." Endocrinology and Metabolism Clinics of North America 29, no. 4 (2000): 683–705. http://dx.doi.org/10.1016/s0889-8529(05)70159-6.

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31

umpierrez, Guillermo E., Mahsheed Khajavi, and Abbas E. Kitabchi. "Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar Nonketotic Syndrome." American Journal of the Medical Sciences 311, no. 5 (1996): 225–33. http://dx.doi.org/10.1016/s0002-9629(15)41700-8.

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32

RIMAILHO, ALAIN, BRUNO RIOU, ERIC DADEZ, CHRISTIAN RICHARD, and PHILIPPE AUZEPY. "Prognostic factors in hyperglycemic hyperosmolar nonketotic syndrome." Critical Care Medicine 14, no. 6 (1986): 552–54. http://dx.doi.org/10.1097/00003246-198606000-00007.

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33

Umpierrez, Guillermo E., Mahsheed Khajavi, and Abbas E. Kitabchi. "Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar Nonketotic Syndrome." American Journal of the Medical Sciences 311, no. 5 (1996): 225–33. http://dx.doi.org/10.1097/00000441-199605000-00006.

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34

Matsumura, Kiichiro, Masahiro Sonoh, Akira Tamaoka, and Manabu Sakuta. "Syndrome of opsoclonus-myoclonus in hyperosmolar nonketotic coma." Annals of Neurology 18, no. 5 (1985): 623–24. http://dx.doi.org/10.1002/ana.410180521.

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35

Lin, Jen-Jar, Daniel W. McKenney, Cathy Price, Ray R. Morrison, and William E. Novotny. "Continuous venovenous hemodiafiltration in hypernatremic hyperglycemic nonketotic coma." Pediatric Nephrology 17, no. 11 (2002): 969–73. http://dx.doi.org/10.1007/s00467-002-0947-6.

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36

YILDIZ, Mustafa, Çetin GÜL, and Gültaç ÖZBAY. "Hyperosmolar hyperglycaemic nonketotic coma associated with acute myocardial infarction." Acta Cardiologica 57, no. 4 (2002): 271–74. http://dx.doi.org/10.2143/ac.57.4.2005425.

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37

Tuna, Mazhar Muslum, Faruk Kilinc, Zafer Pekkolay, Hikmet Soylu, and Alpaslan Kemal Tuzcu. "A case of mediastinitis accompanied with hyperosmolar nonketotic coma." Turkish Journal of Emergency Medicine 16, no. 2 (2016): 75–76. http://dx.doi.org/10.1016/j.tjem.2015.04.001.

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38

Balzan, M., and J. M. Cacciottolo. "Neuroleptic Malignant Syndrome Presenting as Hyperosmolar Non-ketotic Diabetic Coma." British Journal of Psychiatry 161, no. 2 (1992): 257–58. http://dx.doi.org/10.1192/bjp.161.2.257.

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A 50-year-old man presented with hyperosmolar nonketotic diabetic coma associated with the neuroleptic malignant syndrome (NMS) after intramuscular treatment with haloperidol. It is suggested that NMS may occur as a complication of uncontrolled diabetes mellitus with dehydration. Conversely, NMS might precipitate diabetic coma in patients with previously well controlled blood glucose.
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39

Arabacı, Melike, Nuray Doğan, Mustafa Tokdemir, Adnan Güçlü, Haluk Mergen, and Kurtuluş Öngel. "Hyperosmolar hyperglycemic nonketotic syndrome in a Turkish family medicine clinic." Opsta medicina 20, no. 1-2 (2014): 52–54. http://dx.doi.org/10.5937/opmed1402052a.

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40

Bala, Marta I., Anibal Chertcoff, Miguel Saucedo, et al. "Teaching NeuroImages: Nonketotic hyperglycemic hyperosmolar state mimicking acute ischemic stroke." Neurology 95, no. 18 (2020): e2600-e2601. http://dx.doi.org/10.1212/wnl.0000000000010649.

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41

McCombs, Darlene G., Susan J. Appel, and Marcie E. Ward. "Expedited diagnosis and management of inpatient hyperosmolar hyperglycemic nonketotic syndrome." Journal of the American Association of Nurse Practitioners 27, no. 8 (2015): 426–32. http://dx.doi.org/10.1002/2327-6924.12205.

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42

Tiras, Sinan, Vincent Haas, Laurent Chevret, et al. "Nonketotic Hyperglycemic Coma in Toddlers After Unintentional Methadone Ingestion." Annals of Emergency Medicine 48, no. 4 (2006): 448–51. http://dx.doi.org/10.1016/j.annemergmed.2006.02.023.

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43

Akcakus, Mustafa, Turkan Patiroglu, Mehmet Keskin, Esat Koklu, and Ali Gozukucuk. "Nonketotic Hyperosmolar Coma Associated With Splenic Rupture in Congenital Afibrinogenemia." Journal of Pediatric Hematology/Oncology 26, no. 10 (2004): 668–71. http://dx.doi.org/10.1097/01.mph.0000142490.72040.23.

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44

Green, D. A. "Nonketotic Hyperosmolar Diabetic Coma in an Infant with down Syndrome." Clinical Pediatrics 38, no. 5 (1999): 317–18. http://dx.doi.org/10.1177/000992289903800517.

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45

Azam, H., R. W. Newton, A. D. Morris, and C. J. Thompson. "Hyperosmolar nonketotic coma precipitated by lithium-induced nephrogenic diabetes insipidus." Postgraduate Medical Journal 74, no. 867 (1998): 39–41. http://dx.doi.org/10.1136/pgmj.74.867.39.

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46

Balasubramaniyam, Nivas, Chandrasekar Palaniswamy, Virusankulam K. Rajamani, Gopalakrishnan Subbiah, Jayageetha Nivas, and Dhana R. Selvaraj. "Hyperosmolar Hyperglycemic Nonketotic Syndrome Presenting With Hemichorea-Hemiballismus: A Case Report." Journal of Neuropsychiatry and Clinical Neurosciences 23, no. 3 (2011): E16—E17. http://dx.doi.org/10.1176/jnp.23.3.jnpe16.

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47

ROSENTHAL, NORMAN R., and EUGENE J. BARRETT. "An Assessment of Insulin Action in Hyperosmolar Hyperglycemic Nonketotic Diabetic Patients." Journal of Clinical Endocrinology & Metabolism 60, no. 3 (1985): 607–10. http://dx.doi.org/10.1210/jcem-60-3-607.

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48

Shuster, Joel. "Heparin-Induced Thrombocytopenia; Hepatotoxicity with Newer Diabetes Agent; Acute Myocardial Infarction Associated with Albuterol; Olanzapine-Induced Hyperglycemic Hyperosmolar Nonketotic Coma; Paronychia and Skin Hyperpigmentation Due to Gefitinib; Selective Serotonin Reuptake Inhibitor-Induced Enuresis; Do Antidepressants Confer a Decreased Risk for Myocardial Infarction?; Recent Adverse Event Reviews; An Online Interview Discussing the Reduction of ADRs." Hospital Pharmacy 40, no. 1 (2005): 18–22. http://dx.doi.org/10.1177/001857870504000103.

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49

Fujioka, Masayuki, Kazuo Okuchi, Hideaki Iwanaga, and Toshisuke Sakaki. "Acute obstructive hydrocephalus due to brain-stem edema caused by hyperosmotic insult." Journal of Neurosurgery 81, no. 4 (1994): 627–28. http://dx.doi.org/10.3171/jns.1994.81.4.0627.

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✓ The case of a 63-year-old man with acute obstructive hydrocephalus is presented. To the authors' knowledge, this is the first reported case of acute obstructive hydrocephalus associated with nonketotic hyperosmolar diabetic coma. It is believed that the plasma hyperosmolality resulted in osmotic endothelial injury leading to brain-stem edema.
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50

Amin, Ami, Bhavika Gandhi, Steven Torre, et al. "Rhabdomyolysis-Induced Acute Kidney Injury in Diabetic Emergency: Underdiagnosed and an Important Association to Be Aware of." Case Reports in Medicine 2018 (October 31, 2018): 1–3. http://dx.doi.org/10.1155/2018/4132738.

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Rhabdomyolysis is a potentially life-threatening clinical syndrome associated with muscle injury which can cause a leakage of intracellular contents, manifested from the range of being asymptomatic to a life-threatening condition causing acute kidney injury and severe electrolyte abnormalities. Rhabdomyolysis has been associated with both diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic nonketotic syndrome, though there is an increased association with rhabdomyolysis and acute kidney injury with hyperosmolar nonketonic state compared with patients with diabetic ketoacidosis. Common c
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