The syndrome of hyperglycemic, hyperosmolar, nonketotic coma in diabetes came to general attention with its description by Sament and Schwartz1 in 1957. More than 100 cases have now been reported. Blood glucose may be 1000 mg/100 ml or higher; serum sodium is usually elevated (in one case it was 188 mEq/liter) but may be normal; serum carbon dioxide is normal or slightly to moderately depressed; blood urea nitrogen is four to ten times normal; and serum osmolarity ranges between 300 and 500μ Osm/kg H2O. Dehydration is severe and occasionally convulsions occur. Most patients have been middle-aged or older and have proved eventually to have mild diabetes. Recently, however, two cases in young, insulin-requiring diabetics have been reported.
In the earlier cases, precipitating causes were rarely identified, and patients seemed to slip quietly into coma following a period of polyuria and thirst. In the past few years, however,