Hyperosmolar and Other Types of Nonketoacidotic Coma in Diabetes

In patients with hyperosmolality as the sole cause or as an important factor in the production of the coma, therapy with hypotonic or isotonic fluids and with insulin, often in amounts less than those generally used in diabetic ketoacidosis, has proved effective in restoring consciousness in many, but not all, instances of hyperosmolar coma. The mortality, however, has been high, usually because of uremia, stroke, massive infection, pancreatitis, etc.