Isosmolar coma

In 4 neonates the development of an isosmolar coma during parenteral alimentation with protein hydrolysate in excess of 4 g/kg/day has been observed. This hitherto unreported complication of parenteral nutrition is characterized by increasing stupor, diminished muscular activity and finally frank coma. These manifestations developed within 6—12 hours after the protein content of the infusate, casein, protein hydrolysate (Cutter) had been increased to or beyond 4 g/kg/day. During the coma, the serum osmolality was normal, the specific gravity of the urine decreased. Reversal of the clinical symptoms occurred promptly when the protein-containing infusion was discontinued (43 ). 

Touloukian, R. J. (1975) Isosmolar coma during parenteral alimentation with protein hydrolysate in excess of 4 gm/kg/day. /. Pediat., 86, 270. 

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