The hipermolal coma as first manifestation of type 2 diabetes in the 67-year-old patient

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)