A patient with diabetes mellitus may become comatose without evidence of ketoacidosis if the serum osmolarity becomes markedly elevated. Often the patient is elderly with comorbid conditions.
Clinical findings:
(1) depressed level of consciousness
(2) dehydration
(3) often an acute precipitating event (acute infection, myocardial infarction, etc.)
Laboratory findings:
(1) hyperglycemia (typically > 500 mg/dL)
(2) markedly elevated serum osmolality (due to combination of elevated glucose and dehydration), often > 320 mOsm per kg water
(3) absence of ketoacidosis
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