Coma and Hyperglycemia in the Absence of Ketonemia

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Abstract
HISTORY.—A 12-year-old white boy was admitted to the Childrens Hospital with a two-day history of emesis and abdominal pain followed by coma. He was considered to be well until two days before admission, at which time he complained of mild anorexia and generalized abdominal discomfort. He slept well that night, but on the following day emesis and upper abdominal pain occurred after each meal. The following morning he was found to be semicomatose. He was immediately taken to another hospital where dehydration and abdominal rigidity were noted on physical examination. The hemoglobin was 12 gm/100 cc; white blood cell count (WBC), 23,000 with 72% segmented neutrophils. Blood sugar was 500 mg/100 cc, and a blood amylase was 170 units. Over the next five hours, 200 units regular insulin and 3,000 cc of 2/3 normal saline were administered intravenously. He was then referred to this hospital. The family history was noncontributory.

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