1/3. organophosphate poisoning presenting as diabetic ketoacidosis.A 3-year-old boy was admitted to hospital following rapid-onset coma. Laboratory tests demonstrated hyperglycemia, glycosuria and keto-acidosis. Organophosphorus poisoning was the cause of the coma since he had been in contact with parathion, serum cholinesterase activity was undetectable and his condition returned to normal under atropine therapy.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
2/3. Hyperosmolar non-ketotic coma in diabetic stroke patients.Hyperosmolar non-ketotic coma in diabetes is a life-threatening condition. We describe three patients, aged 59-67 years, who developed hyperosmolar coma during the first ten days after admission for stroke. Common to all three were normal plasma osmolality and slightly elevated plasma creatinine levels on admission, treatment with diuretics, parenteral dextrose administration before and low urinary glucose output during the coma. In the five days preceding the coma, total fluid deficits were 3.8, 6.5 and 9.4 1, respectively. In one patient the rate of glucose delivery had clearly exceeded utilization during adequate insulinization, in another a marked reduction in urinary glucose output preceded extreme hyperglycaemia and coma. Two of the three patients died, both from extensive thrombus formation in cerebral arteries and multiple emboli to the lungs. We conclude that enhanced endogenous glucose production and reduced renal clearance of glucose may contribute to precipitate hyperosmolar non-ketotic coma. A close monitoring of fluid and dextrose administration seems mandatory in diabetic stroke patients, in particular if renal function is impaired or if diuretics are given. insulin treatment should be considered in all diabetic patients during the first days after a stroke.- - - - - - - - - - ranking = 5keywords = coma (Clic here for more details about this article) |
3/3. Hypophosphataemic osteomalacia associated with a malignant tumour of the tibia: report of a case.A case of vitamin d resistant hypophosphataemic osteomalacia with glycosuria and aminoaciduria is reported. The course of the disease was dramatically altered by the removal of a bone sarcoma which probably had been growing slowly since the onset of the patient's symptoms five years previously. The histology and electron microscopy of the tumour are described. Three years after the operation the patient remains free of symptoms.- - - - - - - - - - ranking = 0.5keywords = coma (Clic here for more details about this article) |