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


To read more or access our algorithms and calculators, please log in or register.