Typically, HHNK syndrome starts slowly. Over days or weeks, the patient experiences extreme thirst and excessive urination. Because these early signs and symptoms may be mistakenly attributed to another cause, appropriate medical care may not begin until after she becomes stuporous or comatose.Other common signs and symptoms include weight loss, weakness, anorexia, nausea, vomiting, tachycardia, hypotension, orthostatic hypotension, dry skin and mucous membranes, and poor skin turgor. Many patients with HHNK syndrome develop progressive neurologic deterioration, including decreased responsiveness, confusion, lethargy, seizures, focal deficits, paralysis, and hemiparesis or hemisensory loss.