PubMed · 7521718
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S M MacDonald, R L Fainsinger. 1994. Symptom control: the problem areas.. https://doi.org/10.1177/026921639400800212
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Two patients, men aged 47 and 64 years, were found in a comatose condition in their homes, after a period of fatigue, polyuria and polydipsia. They had not been known to suffer from diabetes mellitus, but now displayed a hyperglycaemic hyperosmolar non-ketoacidotic disorder as the first manifestation of diabetes mellitus type 2. In that condition, just sufficient insulin is present to counteract ketone production, but not enough to prevent hyperglycaemia. Neurological and thromboembolic manifestations, possibly fatal, may result from severe dehydration brought about by a vicious circle in which osmotic diuresis reduces the effective circulating volume, causing renal function to decrease and hyperglycaemia to increase even more. Both patients recovered fully after adequate treatment with solutions of NaCl and glucose.