Abstract
A case of hyperosmolar hyperglycemic nonketotic coma (HHNC) caused by severe dehydration as a result of fasting during Ramadan for religious reasons is reported. A 50-year-old Indonesian man was admitted because of a consciousness disorder which occurred on the 11th day of Ramadan. He had no history of diabetes. His skin and tongue were extremely dry on admission. Laboratory data revealed a serum glucose level of 734mg/dl, sodium of 151mg/dl, and serum osmolality of 363m0sm/kg. Arterial blood gas analysis revealed a pH of 7.321 and HCO-3 of 20.9mEq/l. A small dose of short-acting insulin and 0.45% saline were infused immediately, and 19 hours after the start of treatment, the patient recovered from his HHNC. It is a well known fact that HHNC is sometimes caused by iatrogenic factors, certain drugs or postoperative hyperalimentation. Fasting may also be a precipitating factor for HHNC in diabetic patients, so such patients must pay adequate attention to dehydration.
