Hyperosmolar nonketotic coma at the onset of type I diabetes in a child.
A 12 yr-old child without any past medical history of diseases was admitted to hospital for sopor and polyuria. At admission he was markedly dehydrated. Blood glucose was 72 mmol/l, sodium 154 mmol/l, osmolarity 381 mOsm/Kg, urinary ketons were negative. He was rehydrated with hypotonic saline and treated with insulin. The osmolality and sodium initially increased to 176 mmol/l and 408 mOsm/Kg respectively and progressively decreased to normal levels. Serum transaminases increased to GOT 336 and GPT 209 U/l in the first days of treatment and normalized after 15 days. The anti-islet antibodies were positive. The non ketotic hyperosmolar coma and Type I diabetes is rare in children but this possibility must be kept in mind especially when some familial or psychological problems are present as in our case.
Basso
A
A
Divisione Malattie del Ricambio, Ospedale S. Bortolo Vicenza, Italy.
Dalla Paola
L
L
Erle
G
G
Nacamulli
D
D
Armanini
D
D
D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D006944:Hyperglycemic Hyperosmolar Nonketotic Coma / Q000209:etiology* / Q000503:physiopathology; D006955:Hypernatremia / Q000503:physiopathology; D008099:Liver / Q000503:physiopathology; D008297:Male; D018908:Muscle Weakness / Q000209:etiology; D015431:Weight Loss