Abstract
To Editor:— In their recent article Acute Quadriplegia in Diabetic Hyperosmotic Coma With Hypokalemia ( 207 :2278, 1969), Manzano and Kozak presented case of a 42-year-old man with diabetes in hyperosmotic coma with hypokalemia, in whom severe quadriplegia developed as glucose and potassium levels were being restored to normal levels. They stated that the exact etiology of paralysis could not be determined. In reviewing many tests carried out on this patient, I was surprised not to find results of nerve conduction studies. These would have provided quantitative information on nerve function, and might have been a diagnostic help. The three conditions considered in differential diagnosis—hypokalemia, diabetic neuropathy, and Guillain-Barre syndrome—each produce a characteristic alteration of peripheral nerve physiology. In hypokalemia, nerve conduction velocities are generally normal, even at time of potassium depletion and weakness. However, electromyography done during period of hypokalemia shows
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