title: Nonketotic hyperosmolar coma in a patient with type 1 diabetes-related diabetic nephropathy: case report.
abstract: Nonketotic hyperosmolar coma (NHC) is characterized by severe hyperglycemia; absence of, or only slight ketosis; nonketotic acidosis; severe dehydration; depressed sensorium or frank coma; and various neurologic signs. This condition is uncommon in type 1 diabetes. Because of little or no osmotic diuresis in patients with diabetic nephropathy, increases in plasma osmolality and therefore the likelihood of neurologic symptoms are limited. A 20-year-old male patient with type 1 diabetes with chronic kidney disease on conservative treatment (glomerular filtration rate [GFR], 18 mL/dk) presented with acute nonketotic hyperosmolar syndrome. The patient was admitted presenting with thirst, fatigue, and drowsiness. Blood biochemistry levels were urea 87 mg/dL, creatinine 5.09 mg/dL, glucose 830 mg/dL, glycosylated hemoglobin (HbA1c) 8%, C peptide <0.3 ng/mL, sodium 131 mmol/L, chloride 93 mmol/L, potassium 5.2 mmol/L, and calculated serum osmolality 385 mOsm/kg. The presumptive diagnosis on admission was nonketotic hyperosmolar syndrome precipitated by urinary infection. This is the first case report of hyperosmolar coma in a patient with type 1 diabetes with chronic kidney disease.
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Yüzüncü Yil University, Van, Turkey.
authors.forename: Ekrem
authors.initials: E
authors.lastname: Dogan
authors.forename: Reha
authors.initials: R
authors.lastname: Erkoc
authors.forename: Hayriye
authors.initials: H
authors.lastname: Sayarlioglu
authors.forename: Akif
authors.initials: A
authors.lastname: Buyukbese
mesh_terms: D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003928:Diabetic Nephropathies / Q000150:complications*; D006801:Humans; D006944:Hyperglycemic Hyperosmolar Nonketotic Coma / Q000175:diagnosis* / Q000209:etiology; D008297:Male