[Hyperosmolar diabetic coma without ketoacidosis in purulent meningitis (author's transl)].

Hyperosmolar diabetic coma without ketoacidosis was observed as a complication of purulent meningitis in 3 patients. Diagnostic difficulties arise due to slow onset of hyperosmolality and misinterpretation of organic cerebral fits and the increasing disturbance of consciousness. Therapy is complicated by the necessity of treatment with anticonvulsants and sodium containing antibiotics which affect sugar and sodium balance. Abrupt lowering of serum osmolality leads to further increase of cerebral oedema. Slow normalisation of blood sugar and sodium values over several days may lead to satisfactory outcome despite unconsciousness of long duration. These complications could be overcome with high doses of insulin and large amounts of hypotonic infusion in two patients, one female succumbed.