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Non Ketotic Hyperosmolar Coma
- severe hyperglycaemia without significant ketosis
- characteristically occurs in NIDDM / type II diabetes
Presentation
- middle to later life
- precipitants
- glucose-rich fluids (Lucozade)
- concurrent medication
- thiazide diuretics
- steroids
- intercurrent illness
Pathology
- age-related
- thirst experienced less readily
- renal function impaired
- degree of insulin deficiency
- endogenous levels sufficient to prevent hepatic ketogenesis
- glucose production unrestrained
Clinical Features
- dehydration
- stupor / coma
- evidence of underlying illness
- complications
- stroke
- myocardial infarction
- arterial insufficiency of lower limb
Investigations
Treatment
- fluids
- insulin infusion (not too fast)
Prognosis
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