Hyperosmolar non-ketotic
coma in diabetes is a life-threatening condition. We describe three patients, aged 59-67 years, who developed hyperosmolar
coma during the first ten days after admission for
stroke. Common to all three were normal plasma osmolality and slightly elevated plasma
creatinine levels on admission, treatment with
diuretics, parenteral
dextrose administration before and low urinary
glucose output during the
coma. In the five days preceding the
coma, total fluid deficits were 3.8, 6.5 and 9.4 1, respectively. In one patient the rate of
glucose delivery had clearly exceeded utilization during adequate insulinization, in another a marked reduction in urinary
glucose output preceded extreme hyperglycaemia and
coma. Two of the three patients died, both from extensive
thrombus formation in cerebral arteries and multiple emboli to the lungs. We conclude that enhanced endogenous
glucose production and reduced renal clearance of
glucose may contribute to precipitate hyperosmolar non-ketotic
coma. A close monitoring of fluid and
dextrose administration seems mandatory in diabetic
stroke patients, in particular if renal function is impaired or if
diuretics are given.
Insulin treatment should be considered in all diabetic patients during the first days after a
stroke.