[Diabetic hyperosmolality. Retrospective study of 60 cases].
OBJECTIVE
Our aims were to determine the frequency of diabetic hyperosmolality (DH) in our Department, its causes, therapeutic implications and evolution. A five-years retrospective study was performed in 60 patients regarding age, sex, type and duration of diabetes mellitus (DM), previous antidiabetic therapy, underlying diseases, biochemical data, precipitating factors, therapeutic management and outcome.


RESULTS
The hyperosmolar coma was responsible for 90% of the metabolic comas and for 3% of the diabetic patients. The median age of the cohort was 54.6 +/- 9.4 years, being females 61.7% and males 38.3% In 40% no prior diagnosis of DM was made and in the remaining patients the previous antidiabetic therapy was unknown in 61%. Altered consciousness was found in 90%, being 28% in coma. The metabolic acidosis was detectable in 22.2%, the average glycaemia was 956 +/- 267 mg/dl and the osmolality was 349.4 +/- 34.3 mosm/l. The precipitating factors were: poor metabolic control in all patients (HbA1C 12.5 +/- 2.75%), infections in 76.6%, suspension of antidiabetic therapy in 10% and concomitant hyperglycaemic drugs in 6.6% of patients. The global mortality was 20%.


CONCLUSIONS
The majority of the situations could be preventable if an attempted screening and diagnosis of DM was made and precipitating factors avoid or promptly treated.
Campos
Maria Vítor
MV
Serviço Endocrinologia, Diabetes e Metabolismo dos Hospitais da Universidade de Coimbra.
Bastos
Margarida
M
Martins
Teresa
T
Leitão
Patrícia
P
Lemos
Manuel
M
Carvalheiro
Manuela
M
Ruas
Almeida
A
D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000453:epidemiology*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000453:epidemiology; D016883:Diabetic Ketoacidosis / Q000453:epidemiology; D005260:Female; D038321:Glycemic Index; D006801:Humans; D006944:Hyperglycemic Hyperosmolar Nonketotic Coma / Q000097:blood / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009994:Osmolar Concentration; D011174:Portugal / Q000453:epidemiology; D012189:Retrospective Studies