Clinical Manifestation and Prognostic Factors in Nonketotic Hyperosmolar Coma

Kim, Bo Wan; Kim, Jung Guk; Ha, Sung Woo; Lee, Hyun Jeong; Han, Jeung Hun; Jung, Sang Won; Nam, Jick Hwa; Park, Si Hyung; Lee, Soon Hee

Abstract

BACKGROUND: Nonketotic hyperosmolar coma is usually a complication of non-insuli#n dependent diabetes and a syndrome of profound dehydration, hyperglycemia and hyperosmolarity. Therefore the patients present a progressive mental change. We evaluated the clinical manifestations of nonketotic hyperosmolar coma to assess the correlation between initial clinical manifestations and responses to treatment in patients with nonketotic hyperosmolar coma.
METHODS
We studied 31 patients who had experienced proven nonketotic hyperosmolar coma at Kyungpook National University Hospital from March 1987 to February 1998. We divided nonketotic hyperosmolar coma patients into two groups, tbe complete recovery group and the incomplete recovery group, and compared clinical features and laboratory findings between these two groups.
RESULTS
l) A total of 31 patients were studied. Eighteen patients were in the complete recovery group and thirteen patients were in the incomplete recovery group. 2) Mean age was 63.1+10.1 years old, initial blood glucose was 781.8+314.3 mg/dL, effective osmolarity was 342.6+34.9 mosm/L, arterial pH was 7.34. Serum creatinine level was 241.7+130.0 uol/L and BUN was 23.1+12.5 mmol/L. 3) Among clinical features of both groups (complete recovery and incomplete recovery groups), initial systolic blood pressure was 131.4+26.1 mmHg and 104.1+28.6 mmHg, diastolic blood pressure was 90.6+16.5 mmHg and 63.2+17.4 mmHg, and mean arterial blood pressure was 104.2 +18.2 mmHg and 76.8+19.7 mmHg. They revealed a significant difference statistically. 4) Arterial blood pH was 7.40 and 7.25, BUN was 18.4+11.7 mmol/L and 29.5+11.1mmol/L, and WBC count was 13850+4122/ mm and 19823+ 5946/mm. They revealed a significant difference statistically. 5) We also analyzed the significant factors together using multivariate logistic regression analysis. The only significant independent factor responsible for prognosis of nonketotic hyperosmolar coma was initial mean arterial blood pressure.
CONCLUSION
Nonketotic hyperosmolar coma occurred more frequently in patients who were older and had abnormal renal function. The prognosis of patients was related with mean arterial blood pressure independently. Mean arterial blood pressure thought to be related to intravascular volume and arterial hypotension seems to reflect dehydration state. In conclusion, prevention and rapid correction of hypotension due to dehydration in older diabetics is the most important treatment to improve the prognosis.