Nonketotic hyperosmolar coma in the postoperative patient

Abstract

1. 1. A patient with postoperative hyperglycemic hyperosmolar dehydration and coma in the absence of ketoacidosis is described. 2. 2. The significance of this complication of diabetes in the postoperative state is discussed, and the various factors associated with anesthesia, medication, and postoperative electrolyte and fluid disturbances which add to the difficulty of diagnosis are noted. 3. 3. The possibility of this condition should be appreciated in the diabetic patient, particularly in the nondiabetic elderly obese patient, so that prophylactic measures can be taken and adequate fluid replacement carried out. 4. 4. If the full blown syndrome develops, immediate and rapid infusion of large volumes of hypotonic solutions with the requisite amounts of insulin should be given.