[Non-ketotic hyperglycaemic coma with diabetic lipaemia and hyponatraemia (author's transl)]

A 68-year old male patients without personal or family history of diabetes mellitus developed diabetic lipaemia with severe hyponatraemia and became deeply comatose. The low blood sodium level (110 mmol/l) was consecutive to hyperglycaemia (45 mmol/l), hyperlipaemia (65 g/l) and true sodium depletion. This rare form of type V hyperlipidaemia is attributed to deficiency of heparin-activated lipoprotein lipase; it rapidly responds to insulin therapy. Hyponatraemia is a prominent feature of the syndrome, but it is partly due to blood dilution resulting from hyperglycaemia and therefore fictitious. For accurate measurement of sodium depletion blood sodium levels must be adjusted taking into account blood lipoprotein and glucose levels.