[Transitory ECG changes of an ischemic type during hyperosmolar non-ketoacidotic coma]

Hyperosmolar coma was the presenting feature of type I diabetes in a 20 year old man. Ischemic ECG abnormalities (downsloping ST depression of 5 mm in the anterior leads) were present during the comatose state but not in the following days, when a satisfactory metabolic control was achieved. Coronary heart disease was excluded on the basis of the normal response to a treadmill test carried out 6 months later. Hyperglycemia, hypokalemia, shock, hyperventilation and perhaps hyperosmolarity are responsible for these ECG changes. Caution must be used before considering such ECG patterns as ischemic in patients with this type of coma.