PEDIATRICS Vol. 77 No. 5 May 1986, pp. 770-772
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Nonketotic Hyperosmolal Diabetic Coma in a Child: Management With Low-Dose Insulin Infusion and Intracranial Pressure Monitoring

Donald D. Vernon MD1 and Daniel C. Postellon MD1

1 From the Department of Pediatrics, University of Miami, and Jackson Memorial Hospital, Miami, and Department of Pediatrics, Wayne State University, and Division of Endocrinology, Children's Hospital of Michigan, Detroit

Nonketotic hyperosmolal diabetic coma, which is rare in children, is associated with a high mortality in both children and adults. We report a case of nonketotic hyperosmolal diabetic coma in a 3frac12-year-old child, who was successfully managed with low-dose insulin infusion and invasive intracranial pressure monitoring and recovered without sequelae. Despite severely elevated serum glucose (2,660 mg/dL) and osmolality (435 mosm/kg) levels, there was no elevation of intracranial pressure during her treatment. This case illustrates that insulin should be used cautiously and at low dose in this disease, and that intracranial pressure monitoring is of use in the management of such patients. The pathogenesis and clinical features of nonketotic hyperosmolal diabetic coma are briefly reviewed.

Key Words: nonketotic hyperosmolal diabetic coma • intracranial pressure monitoring

Submitted on August 14, 1985
Accepted on October 29, 1985




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