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We report the case of a boy aged 9 1/2 years with hyperosmolar, nonketotic diabetic coma. He was not known to be diabetic prior to the onset of coma. Pathogenetic aspects of this rare manifestation of juvenile diabetes are discussed. It is dangerous to decrease osmolarity too rapidly during infusion of very hypotonic solutions. Treatment with continuous low-dose insulin infusion may cautiously be tried.
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