抄録
Two cases of hyperosmolar nonketotic coma with neurological disorders are presented.
One was a 49-year-old male, who was admitted because of a brain contusion and a traumatic subarachnoid hemorrhage. At the time of admission, the patient was semicomatose with a mild right hemiparesis; his Glasgow Coma Scale rating was 6. He was treated with glycerol, steroids, and diphenylhydantoin, and his Glasgow Coma Scale rating improved to 10. On the fifth hospital day, he suffered from pneumonia and gastrointestinal bleeding, and was given intravenous hyperalimentation. On the tenth hospital day, he became semicomatose again and his Glasgow Coma Scale rating was 6. The laboratory findings were as follows: blood sugar 675 mg/dl, serum sodium 160 mEq/l, serum blood urea nitrogen 59 mg/dl, plasma osmolarity 404 mOsm/l, and negative keton bodies in the urine. Immediately, he was treated with large amounts of intravenous drip infusion and insulin, and he recovered fully from the syndrome. The other case was a 73-year-old female, who had suffered from a hypertensive intracerebral hematoma.
A close monitoring of fluid, blood sugar, and electrolytes seems to be important for comatose patients. This is particularly true of patients who are dehydrated and given steroids, diuretics, diphenylhydantoin, and intravenous hyperalimentation.
