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The authors report the case of a 12-year-old boy with hyperosmolar nonketotic diabetic coma. Pathogenetic aspects and the HLA genotype are discussed. To reduce the hyperglycaemia, a continuous intravenous infusion of regular insulin at a low rate was used. The too rapidly infused sodium-bicarbonate overloaded tha body with sodium and caused intracellular sodium accumulation with edema. This could explain the disorientation after regaining consciousness. Much more important than the sodium-bicarbonate infusion is an accurate rehydration regimen.
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