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Nonketotic hyperosmolar coma in two diabetic children
Insights
Two diabetic children with nonketotic hyperosmolar coma were successfully treated. Normal lipolytic hormone levels in these patients likely explain the absence of ketosis and normal free fatty acids, unlike in ketoacidotic diabetic coma.
Area of Science:
- Pediatric Endocrinology
- Metabolic Disorders
- Diabetic Coma
Background:
- Nonketotic hyperosmolar coma is a severe diabetic complication.
- Understanding the metabolic differences between nonketotic hyperosmolar coma and ketoacidotic diabetic coma is crucial for effective treatment.
Observation:
- Serial measurements of plasma-free fatty acids, insulin, C-peptide, growth hormone, and cortisol were performed in a child with nonketotic hyperosmolar coma.
- Levels of these analytes remained within normal ranges throughout the coma episode.
Findings:
- The study observed normal levels of lipolytic hormones (growth hormone and cortisol) in a child with nonketotic hyperosmolar coma.
- These normal lipolytic hormone levels correlated with normal plasma free fatty acids and the absence of ketosis.
Implications:
- Findings suggest that normal lipolytic hormone activity may be a key factor differentiating nonketotic hyperosmolar coma from ketoacidotic diabetic coma in children.
- This distinction is vital for guiding therapeutic strategies and improving patient outcomes in pediatric diabetes management.
Abstract:
Two diabetic children with nonketotic hyperosmolar coma were treated successfully. In one of the patients, plasma-free fatty acids, insulin, C-peptide and two lipolytic hormones (growth hormone and cortisol) were measured serially during the coma. Free fatty acids, insulin, C-peptide, growth hormone and cortisol levels were within normal ranges and subsequently these levels did not change significantly. The results suggest that the normal levels of lipolytic hormones may account for the normal plasma free fatty acids and the absence of ketosis found in children with nonketotic hyperosmolar coma, in contrast to the elevated levels of lipolytic hormones and ketone bodies in ketoacidotic diabetic coma.