Neurological Dysfunction Associated With Nonketotic Hyperglycemia

THE RAPIDLY accumulating literature on nonketotic hyperglycemia attests to increased interest in this entity. 1-48 The metabolic abnormalities that define the syn drome have been delineated (Table 1). The necessity for its early recognition and prompt treatment with large quantities of hypotonic fluids and insulin is well established. In contrast, the extent to which neurological dysfunction can result from this metabolic imbalance is not commonly recognized. The fact that some of these patients can present with overt, focal neurological signs 44 is denied 21,40 or minimized. 35 Some interpret their early appearance as evidence that "strokes" are an etiological factor in the development of nonketotic hyperglycemia. 7,48 To others the appearance of focal neurological deficit in the course of the illness signifies the occurrence of "strokes" and such a possibility is listed as a cause of death. 36 Finally, these patients are often simply misdiagnosed as cerebrovascular accidents presenting