Hyperosmolar non-keto-acidotic diabetic coma. A report of three cases and review of the literature.

Three further cases of hyperosmotic non-keto-acidotic and non-lactic-acidotic diabetic coma have been described. A favourable outcome in these patients emphasizes the importance of recognizing this condition in its early stages. This may be difficult as there is no ketosis and no hyperventilation—features that one normally associates with diabetic coma. The signs are those of increasing drowsiness, gross dehydration, and occasionally of circulatory collapse, focal seizures and abdominal pain. Once diagnosed, vigorous treatment must be instituted with large doses of parenteral insulin and intravenous fluids, preferably normal saline initially, followed by mixtures of hypotonic saline and dextrose once the blood sugar has fallen significantly, together with adequate amounts of potassium. In this way it should be possible to reduce the previously high mortality rate.