Hyperglycemic hyperosmolar nonketotic (HHNK) syndrome is a complication of diabetes that primarily affects patients with type 2 diabetes. It is a medical emergency that affects individuals who can produce enough insulin to keep them from a state of acidosis but not enough to counteract the accumulation of excess glucose and the complicating high osmolarity and extracellular fluid loss. This event is frequently precipitated by a stressful event such as infection, trauma, myocardial infarction, thrombolytic events, or acute pancreatitis. It also has been associated with certain medications, such as phenytoin and thiazide diuretics, and procedures, such as peritoneal dialysis. Intravenous solutions containing a high glucose content, such as hyperalimentation
or enteral feedings, have also been documented as precipitating HHNK syndrome. Older patients with a history of type 2 diabetes present with HHNK syndrome along with a recent history of polyuria and inadequate fluid intake.