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Hyperosmolar nonketotic diabetic coma

R Joosten, M Frank, H Hörnchen

    European Journal of Pediatrics
    |October 1, 1981
    PubMed
    Summary
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    A 12-year-old boy experienced hyperosmolar nonketotic diabetic coma. Proper rehydration is crucial, as rapid sodium bicarbonate infusion can cause dangerous fluid overload and edema.

    Area of Science:

    • Pediatric Endocrinology
    • Metabolic Disorders
    • Clinical Case Study

    Background:

    • Hyperosmolar nonketotic diabetic coma (HNKDC) is a severe complication of type 1 diabetes.
    • Understanding the pathogenetic factors and genetic predispositions, such as HLA genotype, is vital for managing HNKDC.
    • This case highlights the challenges in treating HNKDC in pediatric patients.

    Observation:

    • A 12-year-old male presented with HNKDC.
    • Treatment involved continuous low-rate intravenous insulin infusion to manage hyperglycemia.
    • Rapid sodium bicarbonate administration led to sodium overload, intracellular sodium accumulation, and edema.

    Findings:

    • Intravenous insulin infusion effectively reduced hyperglycemia.
    • Inappropriate sodium bicarbonate administration caused significant fluid and electrolyte imbalances.

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  • Edema and disorientation post-treatment were linked to sodium overload.

    • Implications:

    • Accurate and carefully monitored rehydration is paramount in managing HNKDC.
    • The potential risks of rapid sodium bicarbonate infusion in diabetic emergencies must be recognized.
    • This case underscores the importance of individualized treatment protocols in pediatric diabetic ketoacidosis and hyperosmolar states.