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Hyperosmolar non-ketotic coma in diabetic stroke patients
Acta Medica Scandinavica
|January 1, 1982
Summary
Diabetic patients experiencing stroke are at risk for hyperosmolar non-ketotic coma (HNKC). Close monitoring of fluids and glucose, with potential insulin therapy, is crucial for diabetic stroke patients.
Area of Science:
- Neurology
- Endocrinology
- Nephrology
Background:
- Hyperosmolar non-ketotic coma (HNKC) is a severe diabetic complication.
- Stroke patients with diabetes are susceptible to metabolic disturbances.
Observation:
- Three patients (59-67 years) developed HNKC within 10 days of stroke admission.
- Common factors included normal initial osmolality, elevated creatinine, diuretic use, and dextrose administration.
- Significant fluid deficits preceded coma development.
Findings:
- Enhanced endogenous glucose production and reduced renal glucose clearance contribute to HNKC.
- Excessive dextrose administration or decreased urinary glucose excretion can precipitate coma.
- Two patients died due to cerebrovascular thrombosis and pulmonary emboli.
Implications:
- Diabetic stroke patients require vigilant monitoring of fluid balance and glucose levels.
- Caution is advised with diuretic use and parenteral dextrose in this population.
- Early insulin treatment may be beneficial for diabetic patients post-stroke.
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