Hyperosmolar hyperglycemic nonketotic coma.

HHNC is a syndrome of abnormally high serum glucose and osmolality coupled with depressed consciousness and an absence of ketoacidosis. It represents as many as 20 per cent of all cases of severe hyperglycemia and constitutes a life-threatening medical emergency; however, the absence of acidosis and the insidious presentation of the disorder frequently mislead clinicians into dangerously inadequate therapeutic interventions. Aggressive therapy with intravenous fluids and potassium and the judicious use of insulin, in conjunction with careful monitoring of central venous pressure and urine output, form the mainstays of treatment. There is a strong association of HHNC with other underlying serious diseases, the detection and treatment of which are imperative to the adequate resolution of the syndrome.