A Case of Diabetic Non-Ketotic Hyperosmolar Coma with an Increase with Plasma 3-Hydroxybutyrate.
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- KINOSHITA OSAMU
- First Dep. of Medicine, Shinshu University Medical School
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- MASUDA IZURU
- Division of Atherosclerosis, Metabolism and Clinical Nutrition, National Cardiovascular Center
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- SUZUKI MASAAKI
- Division of Atherosclerosis, Metabolism and Clinical Nutrition, National Cardiovascular Center
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- TSUSHIMA MOTOO
- Division of Atherosclerosis, Metabolism and Clinical Nutrition, National Cardiovascular Center
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- NISHIOEDA YASUKO
- Division of Atherosclerosis, Metabolism and Clinical Nutrition, National Cardiovascular Center
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- MATSUYAMA TATSUO
- Division of Atherosclerosis, Metabolism and Clinical Nutrition, National Cardiovascular Center
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- KOJIMA HIDETO
- Third Department of Medicine, Shiga University of Medical Science
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- HARANO YUTAKA
- Division of Atherosclerosis, Metabolism and Clinical Nutrition, National Cardiovascular Center
抄録
We have seen a case of “diabetic non-ketotic hyperosmolar coma” with ketosis. An 84-year-old man was brought into the hospital in a deeply comatous and dehydrated state. The initial blood glucose level was 1252mg/dl with plasma osmolarity of 435 mOsm/l, but no ketonuria was detected by the nitroprusside method (Ketostix). However, the plasma 3-hydroxybutyrate (3-OHBA) level was 5 mM in a newly developed bedside film test. The serum ketone bodies were later found to be 5.56 and 0.82 mmol/l for 3-OHBA and acetoacetate (AcAc), respectively. A marked increase in glucagon, cortisol and ADH with renal dysfunction (creatinine 5.0 mg/dl) were noted. An abnormal electrocardiogram, occular convergence and chorea like movement disappeared after correction of metabolic disturbances. The moderate level of IRI (14 μU/ml) on admission and a good response to glucagon 2 months after admission also indicate that the present case is a typical hyperosmolar non-ketotic coma. Because of a preferential increase in 3-OHBA, ketonuria seemed to be absent in the regular nitroprusside test. Marked dehydration is thought to cause renal dysfunction, and the increase in ADH may have helped to prevent further aggravation of ketoacidosis. We propose to change the term hyperosmolar non-ketotic coma (HNC) to diabetic hyperosmolar coma (DHC), because sometimes patients with hyperosmolar non-ketotic diabetic coma are ketotic, as seen in the present case. Determination of 3-OHBA or individual ketone bodies in blood is important and essential for the differential diagnosis of diabetic coma. The diagnosis of either ketoacidotic or hyperosmolar coma should be made depending on the major expression of ketoacidosis or hyperglycemic hyperosmolarity.
収録刊行物
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- Ｅｎｄｏｃｒｉｎｏｌｏｇｉａ Ｊａｐｏｎｉｃａ
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Ｅｎｄｏｃｒｉｎｏｌｏｇｉａ Ｊａｐｏｎｉｃａ 38 (5), 465-470, 1991
一般社団法人 日本内分泌学会
