Hyperosmolar Nonketotic State in a patient with Type 1 Diabetes Mellitus

A Bhattacharyya, A Howell, A Lakhdar
Dreschfeld described the major comas in diabetes mellitus in an address to the Manchestor Medical Society in 1881 as three different syndromes:

Diabetic Collapse,

The alcoholic form of diabetic coma and

Coma from acetonemia.

He described diabetic collapse in those days as “occurs chiefly in older people,… still stout and well nourished. ..the course of disease slow and protracted…’’. The term hyperosmolar nonketotic State (HONK) is now used to describe this condition. It has been recognized recently that around 10% of cases of HONK are comatose at presentation and coma is a late feature that carries a poor prognosis (2-4) although HONK is a recognized complication in a middle aged and elderly people with type 2 diabetes mellitus, it can rarely occur in ketosis-prone young patients with diabetes mellitus (5,6).We report a middle-aged man with type 1 diabetes mellitus presented with HONK precipitated by chronic poor diabetic control.

Diabetes Today 2000;5:152-3.