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January 21, 1974

Hyperosmolar Diabetic Coma— Ketotic and Nonketotic

JAMA. 1974;227(3):317-318. doi:10.1001/jama.1974.03230160045012

When Sament and Schwartz first reported the occurrence of diabetic coma without ketosis, they broke up a seemingly inseparable cause-and-effect relationship. No longer was it necessary to suspect a laboratory error when ketone bodies were reported absent from the urine or blood of a comatose diabetic; nor was it incumbent to seek an auxiliary diagnosis in order to explain unconsciousness or unexpected death. Nonketotic diabetic coma has emerged as a distinct syndrome mediated by the hyperosmolarity of the blood.

Typically, the patient, a middle-aged or old person with diabetes mellitus of recent onset or without previous history of the disease, lapses into stupor and unconsciousness after manifesting prodromal neurological symptoms, such as convulsions, aphasia, or hemiplegia. His serum glucose level is alarmingly high. His serum sodium content rises with the increasing osmotic diuresis, thus contributing in turn to the serum hyperosmolarity. If left untreated, the extracellular and intracellular dehydration, responsible