title: Reversible tetraplegia due to polyneuropathy in a diabetic patient with hyperosmolar non-ketotic coma.
abstract: 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.
authors.affiliation: Department of Intensive Care, St. Bartholomew's Hospital, Smithfield, London, UK.
authors.forename: D D
authors.initials: DD
authors.lastname: Kennedy
authors.forename: S N
authors.initials: SN
authors.lastname: Fletcher
authors.forename: I R
authors.initials: IR
authors.lastname: Ghosh
authors.forename: J H
authors.initials: JH
authors.lastname: Coakley
authors.forename: J P
authors.initials: JP
authors.lastname: Monson
authors.forename: C J
authors.initials: CJ
authors.lastname: Hinds
mesh_terms: 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