Diabetic Coma : A Review of 69 Cases

Summary Sixty‐nine episodes of diabetic coma occurring in the past five and a half years at the Royal Prince Alfred Hospital have been reviewed. The overall mortality rate was 16% (eleven deaths). Three deaths occurred after recovery from ketosis as a result of concomitant disease. One patient died from a combination of diabetic ketosis and cardiac failure. Two patients were moribund on admission and died soon after arrival with progressive diabetic ketosis. One patient died as a result of bilateral adrenal hæmorrhage. The remaining four patients developed circulatory failure some time after treatment commenced and died as a result of this complication. At autopsy in two of these latter patients no cause for the collapse could be found. Factors found to be associated with a high mortality rate were age over 50 years, a blood sugar level on admission greater than 600 milligrammes per 100 millilitres, loss of consciousness and symptoms of ketosis for more than two days. Factors which seemed to have no bearing on the outcome were the level of plasma bicarbonate, the pulse rate and blood pressure on admission, insulin resistance and the preceding insulin requirements. No serious ill effects due to either hypoglycemia or hypokalæmia were encountered. Attention is drawn to the development in seven patients of sudden hypotension, tachycardia and sometimes anuria some hours after treatment had commenced. These patients were, in general, not shocked on admission and, apart from being among the more severe examples of ketosis, showed no other features distinguishing them from the rest of the series. Initial clinical and biochemical improvement proceeded normally until the collapse occurred. The mortality rate was high (four out of seven). No specific ætiological factor could be demonstrated.