Hyperosmolar coma

Hepatic encephalopathy Hyperbilirubinemia Hypocalcemia Hypercalcemia Hyperparathyroidism Hypoparathyroidism Thiamine deficiency (Wernicke s) encephalopathy Diabetic ketoacidosis Nonketotic hyperosmolar coma Phosphate depletion Hypoglycemia Hypoxemia Hypercapnia... 

Hyperglycemia and diabetes mellitus Hyperglycemia, in some cases extreme and associated with ketoacidosis or hyperosmolar coma or death, has been reported in patients treated with atypical antipsychotics. 

Acute complications of diabetes include diabetic ketoacidosis, hyperglycaemic non-ketotic hyperosmolar coma, lactic acidosis and hypoglycaemia. 

Type II diabetics are less prone to develop ketone bodies or diabetic ketoacidosis but may develop hyperosmolar coma, a condition characterized by severe hyperglycemia and dehydration. Both diabetic ketoacidosis and hyperosmolar coma are medical emergencies that require prompt insulin administration and intravenous fluids. 

When a 45-year-old man with severe lithium-induced diabetes insipidus developed hyperosmolar, nonketotic hyperglycemia, it was suggested that poorly controlled diabetes mellitus may have contributed to the polyuria (684). Prior contact with a female patient who had developed hyperosmolar coma secondary to lithium-induced diabetes insipidus (685) allowed physicians 4 years later to treat her safely after a drug overdose and a surgical procedure, by avoiding intravenous replacement fluids with a high dextrose content (despite stopping lithium several years earlier, the patient continued to put out 10 liters of urine daily) (686). 

MacGregor DA, Baker AM, Appel RG, Ober KP, Zaloga GP. Hyperosmolar coma due to lithium-induced diabetes insipidus. Lancet 1995 346(8972) 413-7. 

If blood glucose levels continued to rise after a meal, the high concentration of glucose would cause the release of water from tissues as a result of the osmotic effect of glucose. Tissues would become dehydrated, and their function would be affected. A hyperosmolar coma could result from dehydration of the brain. 

Central intravenous alimentation has been associated with many problems septicemia (Boeckman C.R. aJ., 1970), thrombosis and thrombophlebitis (Groff, 1969), hypersensitivity reaction (Rea et al., 1970), air embolism (Filler et al., 1970), and hyperosmolar coma (White j 1972). Any of these complications markedly... 

Hyperglycemia (Osmotic diuresis, hyperosmolar coma) hypoglycemia... 

Hyperosmolar coma with extremely high concentrations of blood glucose (often accompanied by a concomitant hypernatremia) may occasionally be seen during the course of total parenteral nutrition, particularly if adequate monitoring is not carried out. This complication has been implicated in several fatalities of total parenteral nutrition. 

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