Acidosis and coma in adult diabetic maintenance dialysis patients with extreme hyperglycemia

Background Extreme hyperglycemia (serum glucose ≥ 800 mg/dL or 44.4 mmol/L) is infrequently associated with impaired consciousness in patients on maintenance dialysis. The purpose of this study was to determine features of extreme hyperglycemia that bring about coma in dialysis patients who do not have any of the potential conditions, other than hyperglycemia, that can affect the sensorium. Methods We analyzed 24 episodes of extreme dialysis-associated hyperglycemia in men who did not have neurological disease or sepsis. We compared serum parameters related to hyperglycemia between a group of 12 patients (8 on peritoneal dialysis, 4 on hemodialysis) who were alert and oriented (group A) and another group of 12 patients (5 on peritoneal dialysis, 7 on hemodialysis) who displayed varying degrees of impairment of sensorium, ranging from drowsiness to coma (group B). Results Group B had, in the serum, lower total carbon dioxide (TCO 2 , 8 ± 4 vs. 20 ± 3 mmol/L, P