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Diabetic hyperosmolar non-ketotic decompensation.

M Small¹, A Alzaid, A C MacCuish

¹University Department of Medicine, Royal Infirmary, Glasgow.

The Quarterly Journal of Medicine

|March 1, 1988

Summary

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Outcome for hyperosmolar non-ketotic decompensation has not improved despite modern medical management. Early diagnosis is crucial, as delays were noted in patients who died from this serious diabetic complication.

Area of Science:

Endocrinology
Metabolic Disorders
Diabetes Mellitus Management

Background:

Hyperosmolar non-ketotic decompensation (HNKD) is a severe complication of diabetes mellitus.
Modern medical advancements have not demonstrably improved HNKD outcomes over the past two decades.

Purpose of the Study:

To evaluate changes in HNKD outcomes over a 20-year period.
To identify prognostic factors for mortality in HNKD patients.

Main Methods:

Retrospective analysis of HNKD patients from 1982-1986 at a major teaching hospital.
Comparison of clinical and laboratory variables between early deaths and survivors.
Assessment of treatment regimens and diagnostic delays.

Main Results:

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A cohort of 22 HNKD patients was identified; 68% had no prior diabetes history.
Immediate (72h) and overall mortality rates were 36% and 41%, respectively.
Vascular thromboembolism was a frequent complication; no significant differences found between deaths and survivors based on initial presentation or treatment.

Conclusions:

There has been no significant improvement in HNKD outcomes in the last two decades.
A high index of suspicion is essential for timely diagnosis and management.
Delayed diagnosis was a significant factor in mortality among some HNKD patients.