Nonketotic hyperosmolar coma

Pathophysiology

Nonketotic coma is usually precipitated by an acute illness, myocardial infarction or stroke. A relative insulin deficiency leads to a serum diabetic ketoacidosis.

Clinical presentation

The increasing hemoconcentration and volume depletion may result in:

• Hyperviscosity and increased risk of thrombosis
• Disturbed mentation
• Neurologic signs including focal signs such as sensory or motor impairments or focal seizures or motor abnormalities, including flacidity, depressed reflexes, tremors or fasciculations.
• Ultimately, if untreated, will lead to death.

Treatment

The treatment involves slow hydration, replacement of electrolytes and intravenous low molecular weight heparins) are often commenced as there is a significant rate of thrombosis in patients with NKHC. Mortality is 30% to 50%.^{[citation needed]}

References

1. ^ Cirasino L, Thiella G, Invernizzi R, Silvani A, Ragaini S (1992). "Hyperosmolar hyperglycemic nonketotic coma in Waldenström's macroglobulinemia associated with type II diabetes and complicated by pulmonary tuberculosis". Recenti progressi in medicina 83 (4): 194–6. PMID 1626111.