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August 18, 1969

Quadriplegia in Diabetic Hyperosmotic Coma

Author Affiliations

University of Washington Hospital Seattle

JAMA. 1969;209(7):1087. doi:10.1001/jama.1969.03160200051022

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