Nonketotic hyperosmolar coma in a patient with type 1 diabetes-related diabetic nephropathy: Case report |
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Authors: | Ekrem Dogan MD Reha Erkoc MD Hayriye Sayarlioglu MD Akif Buyukbese |
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Institution: | (1) Department of Internal Medicine Division of Nephrology, Yüzüncü Yil University, Van, Turkey;(2) Yüzüncü Yil Universitesi Tip Fakultesi Ic Hastaliklari AD, Nefroloji BD, 65200 Van, Turkey;(3) Division of Endocrinology, University of Sutcu Imam, Kahramanmaras, Turkey |
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Abstract: | Nonketotic hyperosmolar coma (NHC) is characterized by severe hyperglycemia; absence of, or only slight ketosis; nonketotic
acidosis; severe dehydration; depressed sensorium or frank coma; and various neurologic signs. This condition is uncommon
in type 1 diabetes. Because of little or no osmotic diuresis in patients with diabetic nephropathy, increases in plasma osmolality
and therefore the likelihood of neurologic symptoms are limited. A 20-year-old male patient with type 1 diabetes with chronic
kidney disease on conservative treatment (glomerular filtration rate GFR], 18 mL/dk) presented with acute nonketotic hyperosmolar
syndrome. The patient was admitted presenting with thirst, fatigue, and drowsiness. Blood biochemistry levels were urea 87
mg/dL, creatinine 5.09 mg/dL, glucose 830 mg/dL, glycosylated hemoglobin (HbA1c) 8%, C peptide < 0.3 ng/mL, sodium 131 mmol/L, chloride 93 mmol/L, potassium 5.2 mmol/L, and calculated serum osmolality
385 mOsm/kg. The presumptive diagnosis on admission was nonketotic hyperosmolar syndrome precipitated by urinary infection.
This is the first case report of hyperosmolar coma in a patient with type 1 diabetes with chronic kidney disease. |
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Keywords: | chronic kidney disease nonketotic hyperosmolar coma type 1 diabetes |
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