Hyperosmolar non-ketotic diabetic coma -- less sodium in therapy?

Eighteen patients with hyperosmolar non-ketotic diabetic coma were studied retrospectively to identify factors affecting prognosis and to review treatment. This condition affected older women two-thirds of whom were unrecognised diabetics. Eight (44%) died. Mortality correlated with age above 60, uraemia and hyperosmolarity, but not with the degree or rate of fall of hyperglycaemia. Hyperglycaemia responded to rehydration and insulin, but in all patients serum osmolarity remained high for several days. In 14 patients (78%) the serum sodium concentration initially increased and in four (22%) serum osmolarity increased. This persistence or worsening of the hyperosmolar state can be avoided without the risk of cerebral oedema by replacing the fluid and electrolyte deficits over 48 hours and using 5% dextrose for the water deficit.