A case of hyperglycemic hyperosmolar non-ketotic coma during anesthesia: a possible cause of failed re-awakening.
The case of a non diabetic 6-year-old boy affected by Down's syndrome, who developed hyperosmolar hyperglycemic non-ketotic coma following the infusion of hypertonic dextrose solution during general anesthesia for a surgical procedure for cryptorchidism is reported. Following surgery, the patient remained deeply comatose and generalized seizures occurred. Hyperosmolarity due to hyperglycemia and acidosis were reduced by administration of insulin at low rate, hypotonic saline and sodium-bicarbonate solutions. The patient's clinical conditions promptly improved following normalization of blood glucose levels. An oral glucose tolerance test performed three months later was normal. The authors emphasize the potential risk of hyperosmolar hyperglycemic non-ketotic coma also in non diabetic patients treated with hypertonic dextrose solutions, during surgery events.
Istituto di Clinica Medica, Università di Sassari, Italy.
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D000768:Anesthesia, General; D001786:Blood Glucose / Q000378:metabolism; D002648:Child; D003456:Cryptorchidism / Q000150:complications / Q000601:surgery*; D004314:Down Syndrome / Q000150:complications*; D005947:Glucose / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D006944:Hyperglycemic Hyperosmolar Nonketotic Coma / Q000188:drug therapy / Q000209:etiology* / Q000628:therapy; D006982:Hypertonic Solutions; D007262:Infusions, Intravenous; D007328:Insulin / Q000627:therapeutic use; D061389:Insulin, Regular, Pork; D008297:Male
D001786:Blood Glucose; D006982:Hypertonic Solutions; D007328:Insulin; D061389:Insulin, Regular, Pork; C000006:insulin, neutral; D005947:Glucose