Abstract
In 160 cases of hyperosmolar nonketotic diabetic coma reported in Japan, 28 cases were accompanied by various renal complications. The mortality rate in the cases with renal complications was extremely high. The 28 cases can be divided into two main categories according to serum sodium concentrations: hypernatremia and hyponatremia. The mean serum sodium concentration of the 10 cases in the former group was 165.1 mEq/l. Nine cases in this group died the coma. The main autopsy finding was glomerulosclerosis. The mean value of the serum concentrations of the 16 cases with hyponatremia was 123.1 mEq/l. In addition to hyperglycemia, hyperosmolarity and elevated blood urea nitrogen, the cases in this group showed hyperkalemia and a decrease in plasma bicarbonate and blood pH, which are findings suggestive of metabolic acidosis. Renal complications in the patients of this group were acute or chronic renal failure, glomerulosclerosis, lupus nephritis and various renal infections including renal abscess, pyelonephritis, and necrotizing papillitis. 13 casesdied while in the coma. It is supposed that such patients suffered severe renal complications, before their death. Peritoneal dialysis or hemodialysis were performed on six patients with signs of acutely developed renal failure during the coma and three of them recovered from the coma. It is thought that these therapeutic procedures might be attempted in cases with acute renal failure. Two cases with normal serum sodium concentrations recovered from the coma though they had renal complications.
Six cases with hyponatremia but no renal complications were present in the 160 cases with hyperosmolar non-ketotic coma in this series. They showed a lower level of serum urea nitrogen than the cases with renal complications. There were no deaths in this group.
