Haupt W F
Dtsch Med Wochenschr. 1980 Nov 7;105(45):1565-9. doi: 10.1055/s-2008-1070912.
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.
3例患者出现了高渗性非酮症糖尿病昏迷，这是化脓性脑膜炎的一种并发症。由于高渗状态起病缓慢、对器质性癫痫发作的误解以及意识障碍不断加重，导致诊断困难。治疗也很复杂，因为需要使用影响糖和钠平衡的抗惊厥药和含钠抗生素。血清渗透压突然降低会导致脑水肿进一步加重。尽管患者长时间昏迷，但血糖和钠值在数天内缓慢恢复正常可能会带来满意的结果。两名患者通过大剂量胰岛素和大量低渗输液克服了这些并发症，一名女性患者死亡。
