Recurrent Hyperosmolar Nonketotic Episodes in a Young Diabetic FREE

H. DORCHY, MD; H. LOEB, MD

Am J Dis Child. 1976;130(7):779. doi:10.1001/archpedi.1976.02120080101015.

Text Size: A A A

Published online

Article

References

Comments

ABSTRACT

ABSTRACT | REFERENCES

Sir.—We wish to comment on the article by Drs Ginsberg-Fellner and Primack that appeared in the February issue of the Journal (129:240-243, 1975). We read with interest the clinical description of this very exceptional case of recurrent hyperosmolar nonketotic diabetes.

Unfortunately, the article does not contain values of blood ketones. However, they probably were not very high since the blood pH was normal. On the other hand in two thirds of the cases described in the literature, the pH values are in the acid range. Since these observations do not mention the levels of blood ketones and lactic acid, it is therefore impossible to determine the origin of the acidosis.

In the article we published,¹ we found the acidosis to be due to an important accumulation of acetoacetate and β-hydroxybutyrate. In our case, the absence of urinary ketone bodies during the phase of oliguria can only be explained by

REFERENCES

ABSTRACT | REFERENCES

Dorchy H, Pardou A, Weemaes I, et al: Coma hyperosmolaire acido-cétosique sans cétonurie initiale . Pediatrie 30:19-27, 1975;.

Laugier J, Grenier B, Dupin M, et al: Coma hyperosmolaire chez un enfant diabétique . Ann Pediatr 16:603-607, 1969;.

Maestraggi P, Roussel A, Mariani R, et al: Coma hyperosmolaire, première manifestation du diabète sucré chez un enfant de 4 ans . Arch Fr Pediatr 27:761, 1970;.

Kiss P: Coma diabeticum hyperosmoticum in Säuglings-und Klein Kindesalter . Kinderaerztl Prax 38:166-172, 1970;.

Thomsen K: Diabetic coma without ketonuria . Acta Paediatr Scand 60:247-248, 1971;.

Dagnone LE, Reid JD, Green RN: Nonketotic hyperosmolar coma with insulin resistance in a 12-year-old girl . Can Med Assoc J 105:940-945, 1971;.

Stahlie TD: Het hyperosmolaire, hyperglykemische, niet keto-acidosische coma bij het kind . Ned Tijdschr Geneeskd 116:2209-2212, 1972;.

Jean R, Dumas R, Morel G, et al: Coma hyperosmolaire inaugural d'un diabète de l'enfant: Intérêt de la rééquilibration par dialyse péritonéale . Pediatrie 27:769-775, 1972;.

Vaan GAM de: Hyperosmolair diabetisch coma zonder Ketoacidose . Maandschr Kindergeneesk 34:279-283, 1966;.

Ehrlich RM, Bain HW: Hyperglycemia and hyperosmolarity in an 18-month-old child . N Engl J Med 276:683-684, 1967;.

Kogut MD, Landing BH: Coma and hyperglycemia in the absence of ketonemia . Am J Dis Child 114:676-683, 1967;.

Rubin HM, Kramer R, Drash A: Hyperosmolarity complicating diabetes mellitus in childhood . J Pediatr 74:177-186, 1969;.

Belmonte MM, Colle E, Murphy DA, et al: Non-ketotic hyperosmolar diabetic coma in Down's syndrome . J Pediatr 77:879-881, 1970;.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal