{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T17:59:01Z","timestamp":1760983141691},"reference-count":23,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[1976,4]]},"abstract":"<jats:p content-type=\"fine-print\">\u2713 Seventy-eight critically ill patients who died while on the neurosurgical service were studied retrospectively to establish the prevalence of nonketotic hyperglycemic hyperosmolar coma (NHHC). All patients had been comatose before death, and all underwent necropsy. Criteria for the diagnosis of NHHC included moderate-to-severe hyperglycemia with glucosuria, absence of significant acetonuria, hyperosmolarity with dehydration, and neurological dysfunction. This study revealed seven cases of unequivocal NHHC (9%), and six of hyperosmolarity but with incomplete records. Five of the seven confirmed cases of NHHC demonstrated no evidence of cerebral edema, transtentorial herniation, or brain-stem damage, and showed central nervous system (CNS) lesions compatible with survival. Fatal complications of this syndrome, such as acute renal failure, terminal arrhythmias, and vascular accidents, both cerebral and systemic, were common in this series. The mechanism of coma in NHHC is believed related to shifts of free water from the cerebral extravascular space to the hypertonic intravascular space, with subsequent intracellular dehydration, accumulation of metabolic products of glucose, and brain shrinkage. It is uncertain whether injury to specific areas in the CNS is a predisposing factor to the development of NHHC. Factors documented to be significant in its development include nonspecific stress to primary illnesses, hyperosmolar tube feedings, dehydration, diabetes, and mannitol, Dilantin, or steroid administration.<\/jats:p>","DOI":"10.3171\/jns.1976.44.4.0409","type":"journal-article","created":{"date-parts":[[2009,5,7]],"date-time":"2009-05-07T15:12:18Z","timestamp":1241709138000},"page":"409-417","source":"Crossref","is-referenced-by-count":15,"title":["Nonketotic hyperglycemic hyperosmolar coma"],"prefix":"10.3171","volume":"44","author":[{"given":"Bert E.","family":"Park","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William F.","family":"Meacham","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin G.","family":"Netsky","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Medicine","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1097\/00005792-197203000-00001","article-title":"Nonketotic hyperosmolar coma with hyperglycemia: clinical features, pathophysiology, renal function, acid-base balance, plasma-cerebrospinal fluid equilibria and the effects of therapy in 37 cases.","volume":"51","author":"Arieff","year":"1972"},{"key":"b2","series-title":"Am J Med","doi-asserted-by":"publisher","first-page":"648","DOI":"10.1016\/0002-9343(67)90066-6","article-title":"Hyperosmolality with hyponatremia, caused by inappropriate administration of mannitol.","volume":"42","author":"Aviram","year":"1967"},{"key":"b3","series-title":"JAMA","doi-asserted-by":"publisher","first-page":"1007","DOI":"10.1001\/jama.1967.03130240049007","article-title":"Hyperosmolar anacidotic coma in association with glucocorticoid therapy.","volume":"202","author":"Boyer","year":"1967"},{"key":"b4","series-title":"Pediatrics","first-page":"46","article-title":"Pathogenesis of lesions in the central nervous system in hyponatremic states. 2. Experimental studies of gross anatomic changes and alterations of chemical composition of the tissues.","volume":"23","author":"Finberg","year":"1959"},{"key":"b5","series-title":"Am J Surg","doi-asserted-by":"publisher","first-page":"652","DOI":"10.1016\/S0002-9610(70)80187-8","article-title":"The surgical significance of hyperosmolar coma.","volume":"120","author":"Flanigan","year":"1970"},{"key":"b6","series-title":"Ann Intern Med","doi-asserted-by":"publisher","first-page":"778","DOI":"10.7326\/0003-4819-68-4-778","article-title":"Hypernatremia, azotemia, and dehydration due to high-protein tube feeding.","volume":"68","author":"Gault","year":"1968"},{"key":"b7","series-title":"Diabetes","doi-asserted-by":"publisher","first-page":"228","DOI":"10.2337\/diab.20.4.228","article-title":"Clinical and metabolic characteristics of hyperosmolar nonketotic coma.","volume":"20","author":"Gerich","year":"1971"},{"key":"b8","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"1116","DOI":"10.1056\/NEJM196505272722109","article-title":"Hypernatremia complicating prolonged mannitol diuresis.","volume":"272","author":"Gipstein","year":"1965"},{"key":"b9","series-title":"Diabetes","doi-asserted-by":"publisher","first-page":"101","DOI":"10.2337\/diab.18.2.101","article-title":"Hyperglycemic, nonketotic coma following administration of Dilantin (Diphenylhydantoin).","volume":"18","author":"Goldberg","year":"1969"},{"key":"b10","series-title":"Am J Med Sci","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1097\/00000441-196809000-00003","article-title":"Serum insulin levels in nonketotic hyperosmotic diabetes mellitus.","volume":"256","author":"Henry","year":"1968"},{"key":"b11","series-title":"Diabetes","doi-asserted-by":"publisher","first-page":"111","DOI":"10.2337\/diab.18.2.111","article-title":"Mechanisms and management of hyperosmolar coma without ketoacidosis in the diabetic.","volume":"18","author":"Johnson","year":"1969"},{"key":"b12","series-title":"Arch Neurol","doi-asserted-by":"publisher","first-page":"525","DOI":"10.1001\/archneur.1968.00480050095009","article-title":"Neurological dysfunction associated with nonketotic hyperglycemia.","volume":"19","author":"Maccario","year":"1968"},{"key":"b13","series-title":"Neurology","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1212\/WNL.15.3.195","article-title":"Focal seizures as a manifestation of hyperglycemia without ketoacidosis. Report of seven cases with review of the literature.","volume":"15","author":"Maccario","year":"1965"},{"key":"b14","series-title":"Med Clin North Am","doi-asserted-by":"publisher","first-page":"683","DOI":"10.1016\/S0025-7125(16)32636-0","article-title":"Hyperosmolar hyperglycemic nonketotic diabetic coma.","volume":"54","author":"McCurdy","year":"1970"},{"key":"b15","series-title":"Metabolism","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1016\/0026-0495(69)90102-4","article-title":"Hyperglycemic, nonketotic coma in the patient with burns: factors in pathogenesis.","volume":"18","author":"Oakes","year":"1969"},{"key":"b16","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1056\/NEJM196907102810208","article-title":"Hyperglycemia with relative hypoinsulinemia in diphenylhydantoin toxicity.","volume":"281","author":"Peters","year":"1969"},{"key":"b17","series-title":"The Diagnosis of Stupor and Coma.","author":"Plum","year":"1972"},{"key":"b18","series-title":"Dis Nerv Syst","first-page":"725","article-title":"Hyperglycemic non-ketotic coma. Role of sodium in the pathogenesis of the neurologic manifestations.","volume":"33","author":"Poser","year":"1972"},{"key":"b19","series-title":"Arch Neurol","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1001\/archneur.1971.00490020044005","article-title":"Hyperglycemia, polyol accumulation, and increased intracranial pressure.","volume":"25","author":"Prockop","year":"1971"},{"key":"b20","series-title":"S Afr Med J","first-page":"893","article-title":"Severe diabetic stupor without ketosis.","volume":"31","author":"Sament","year":"1957"},{"key":"b21","series-title":"Diabetes","doi-asserted-by":"publisher","first-page":"107","DOI":"10.2337\/diab.18.2.107","article-title":"Hyperglycemic, hyperosmolar, nonketoacidotic diabetes. A complication of steroid and immunosuppressive therapy.","volume":"18","author":"Spenney","year":"1969"},{"key":"b22","series-title":"Am J Med Sci","first-page":"485","article-title":"Hyperosmolar coma. Editorial.","volume":"45","author":"Tyler","year":"1968"},{"key":"b23","series-title":"Ann Intern Med","doi-asserted-by":"publisher","first-page":"585","DOI":"10.7326\/0003-4819-47-3-585","article-title":"Extracellular hyperosmolarity secondary to high protein nasogastric tube feeding.","volume":"47","author":"Wilson","year":"1957"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/44\/4\/article-p409.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/44\/4\/article-p409.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/44\/4\/article-p409.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,7,25]],"date-time":"2022-07-25T08:18:15Z","timestamp":1658737095000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/44\/4\/article-p409.xml"}},"subtitle":["Report of neurosurgical cases with a review of mechanisms and treatment"],"short-title":[],"issued":{"date-parts":[[1976,4]]},"references-count":23,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/jns.1976.44.4.0409","relation":{},"ISSN":["0022-3085"],"issn-type":[{"value":"0022-3085","type":"print"}],"subject":[],"published":{"date-parts":[[1976,4]]}}}