Reversible tetraplegia due to polyneuropathy in a diabetic patient with hyperosmolar non-ketotic coma.
Critical illness polyneuromypathy has not previously been reported as a complication of diabetic coma. We describe a patient with hyperosmolar non-ketotic coma (HONK) complicating gram-negative sepsis in whom persistent coma and profound tetraplegia caused considerable concern. Although, initially, it was feared that the patient had suffered a central neurological complication such as stroke or cerebral oedema, a diagnosis of critical illness motor syndrome (CIMS) was subsequently confirmed neurophysiologically. Profound limb weakness associated with HONK is not necessarily due to a catastrophic cerebral event, rather it may be a result of CIMS, which has an excellent prognosis for full neurological recovery.
Kennedy
D D
DD
Department of Intensive Care, St. Bartholomew's Hospital, Smithfield, London, UK.
Fletcher
S N
SN
Ghosh
I R
IR
Coakley
J H
JH
Monson
J P
JP
Hinds
C J
CJ
D000368:Aged; D016638:Critical Illness; D003929:Diabetic Neuropathies / Q000209:etiology*; D004927:Escherichia coli Infections / Q000150:complications*; D005260:Female; D006801:Humans; D006944:Hyperglycemic Hyperosmolar Nonketotic Coma / Q000150:complications*; D011782:Quadriplegia / Q000209:etiology*; D018805:Sepsis / Q000150:complications*; D013577:Syndrome