Vol 12, No 1 (2011): Practical Diabetology
Case report
Published online: 2011-04-28
The hipermolal coma as first manifestation of type 2 diabetes in the 67-year-old patient
Diabetologia Praktyczna 2011;12(1):28-30.
Abstract
Hypermolal coma, which is a hyperglicaemic
hypermolal nonketotic syndrome, is one of three
peracute complications of diabetes. Most often it
follows a delayed diagnosis or inadequate treatment
of type 2 diabetes. It happens also in younger patients
with type 1 diabetes, including children. The most
common factors for hypermolal coma are: heavy
infections with dehydration, acute cardiovascular
diseases, alcoholic intoxication, as well as diuretic and
psychotropic drugs. As regards ethiopathogenesis,
despite a very high glicaemia, neither ketone bodies
nor acidosis were found. Coma is characterized by
high mortality rate, reaching ca. 15% of treated
patients. As far as differential diagnosis is concerned,
one should consider after all: ketotic coma, comatose
state resulting from central nervous system diseases,
uraemic coma, intoxication-induced coma. We
present a clinical case of 67-year-old woman suffering
from a hypermolal coma in previously undiagnosed
diabetes. Initial glicaemia was 107.2 mmol/l. The
patient presented with nonketotic hypermolal coma,
as the first manifestation of type 2 diabetes, and
concomitant respiratory tract infection. The patient
was admitted to the hospital, where after the final diagnosis, appropriate treatment was applied. After
two weeks of treatment, the patient managed to
achieve normalization of glucose level as well as the
results of the remaining laboratory tests. The patient
was released from hospital in a generally good
condition and prescribed three short-acting insulin
injections daily. (Diabet. Prakt. 2011; 12, 1: 28–30)
Keywords: hypermolal comadiabeteshyperglicaemia