A Case of Non-ketotic Hyperosmolar Coma after the Operation of Acute Obstructive Suppurative Cholangitis

Yoji Shiogai, Koichi Matsuda, Hajime Abe, Masashi Kodama*

The Department of Surgery, Yasu Hospital
The First Department of Surgery, Shiga University of Medical*

Both acute obstructive suppurative cholangitis (AOSC) and non-ketotic hyperosmolar coma (NKHC) are fatal diseases if they are left untreated. A 63-year-old male patient with a previous history of non-insulin-dependent diabetes was successfully treated with hypotonic saline infusion and intravenous administration of insulin for NKHC which occurred on the 4th postoperative day after an operation for treatment of AOSC due to choledocholithiasis. The patient recovered completely by the 7th postoperative day. In this case the contrubuting causes of NKHC were a past history of non-insulin-dependent diabetes, severe infectious biliary disease, emergency surgery, total parenteral nutrition, hepatopathy, senility of the patient, etc. In general, NKHC is well treated with massive infusion of hypotonic saline solution and appropriate administration of insulin. NKHC is a disease usually treated by a physisian but in surgical patients the incidence of NKHC has been incresing because of the wider use of total parenteral nutrition and increasing numbers of diabetic patients, Therefore, surgeons also should be familiar with rapid and correct diagnosis and treatment of NKHC.

Key words
postoperative non-ketotic hyperosmolar coma, acute obstructive suppurative cholangitis due to choledocholithiasis

Reprint requests
Yoji Shiogai The Department of Surgery, Yasu Hospital
1094 Yasu-cho, Koshinohara, Yasugun, Shigaken, 520-23 JAPAN

Accepted
January 10, 1990

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