Having just seen my hyperosmolar IDDM 29-yo pt bounce back to our team in DKA after just being released a week ago , let me share with you some of the manifestations I saw:
Diabetic hyperosmolar, non-ketotic coma:
Classically occurs in pts with type 2 diabetes. Typically symptoms in these patients are less severe than patients with DKA. The stereotypical pt is an elderly, obese pt with type 2 who has been physically impaired or ill from other causes that has not been able to take good care of themself, often dehydrated. The hyperglycemia is usually higher than with DKA but without the ketone production. Patients will typically report nausea and vomiting, fatigue, and malaise.
In our patient, he had been taking cocaine the past week or so and had not been using his insulin. He reported nausea but no vomiting, had had no appetite (or perhaps had been skipping his meals?) for about 3 days and was fairly dehydrated. His initial blood glucose was 1060 with no ketonuria. We initiated massive fluid resuscitation, carefully monitoring his potassium, and started IV insulin after getting in the initial bolus of 2 L NS.
thanks that helped alot...I got the questoin right...the question was describinb a patient, coming into the ER with extreme nausea and vomitting...I think she was diabetic, but her ketone labs were negative...and I had narrowed it down to nonketotic hyperosmolar...looks like I guessed it right