Hyperosmolar Hyperglycemic Nonketotic Coma (HHNC) Accompanied with Acute Renal Failure, Rhabdomyolysis and Acute Obstructive Hydrocephalus

A 65 year-old female was admitted to a regional hospital with a complaint of ileus following a total hysterectomy performed 14 years ago. She was treated conservatively by total parental nutrition (TPN). Nine days later she underwent resection of the intestine due to rebound tenderness in the lower abdomen. Infusion toward TPN was resumed the following day after the operation. On the 4th postoperative day she developed restlessness and stupor. She was treated as a hyperosmolar hyperglycemic nonketotic coma (HHNC). She was referred to our intensive care unit (ICU) due to coma and hypotension. Her conscious level was a score of 5 on the Glasgow Coma Scale (GCS). Continuous hemodiafiltration (CHDF) was introduced intermittently due to oliguria. During these treatments, she fell into a deep coma and almost stopped spontaneous respiration on the 10th hospital day. CT scans showed a marked brain stem edema and acute obstructive hydrocephalus. She underwent an emergency ventricular drainage. After these treatments, her consciousness level gradually recovered and subsequently she was transferred to the general ward with a score of 13 on the GCS. Although she had serious complication of renal failure, rabdomyolysis and also hydrocephalus in this case, she was recovered in intensive care. It is advisable to maintain the patients on clinical parameters (monitoring therapy) using CHDF.