Prognostic Factors in the Elderly Diabetic Hyperosmolar Non-ketotic Coma

Park, Min Sook; Yoo, Hyung Joon; Jung, Sun Hwa; Lee, Kwon Yeop; Park, Cheol Soo; Kim, Cheol Hong; Kim, Hyun Gyu; Yoo, Jae Myeog; Kim, Du Man; Ihm, Sung Hee; Choi, Moon Gi; Park, Sung Woo

Abstract

OBJECTIVES
: The diabetic hyperosmolar non-ketotic coma represents an acute complication of diabetes affecting mostly elderly persons with non-insulin dependent diabetes rnellitus. It is characterized by marked hyperglycemia, hyperosmolarity, severe dehydration, occasional neurologic signs, obtunded sensorium, and absence of ketonemia or acidosis. Most investigators have evaluated the relationship of predisposing conditions with HNKC, to evaluate outcome of the elderly HNKC we studied the prognostic factors in the elderly HNKC. Patients and
METHODS
We retrospectively studied 43 patients with HNKC admitted to Hospital of Hallym University during an 6-year period, 1990 through 1995. All medical records of elderly patients (65 years old or more) discharged with the diagnosis of HNKC, were reviewed. To be included as a case, patients had to have a serum glucose level greater than 500mg/dL, measured plasma osmolarity greater than 320mOsm/L, pH greater than 7.30 and disoriented sensorium. 1nformation that was gathered age, glucose, blood urea nitrigen, creatinine, Na+, K+, HCO3-, anion gap, plasma osmolarity, urine osmolarity and whether the patients was discharged alive or died in the hospital. Data were analyzed by one-factor ANOVA and significance of difference between proportions was calculated by Newman-Keuls test.
RESULTS
Survivors of 43 elderly HNKC were 22 patients and non-survivors were 21 patients. Mortality was 49%. Analysis revealed that the plasma osmolarity was significantly higher among those who non-survivors (376 +/- 10.8versus 331 +/- 5.0mOsm/L, p 0.01). Non-survivors also had significantly higher serum creatinine level than survivors (2.1+/-0.41versus 1.6 +/- 0.18mg/dL, p = 0.024) Conelusion: These results suggest that the prognostic factors of elderly HNKC were plasma osrnolarity and serum creatinine level.