Summary of medical history: The patient was a female, 65 years old. She was admitted to the hospital on 2007-4-25.19:05 with fever for 4 days and coma with limb convulsions for 6 hours. She had no clear history of diabetes mellitus, a history of polyphagia, hypertension, cerebral infarction for more than 10 years, and dementia with inability to take care of herself for 5 years. 4 days ago she had a fever with a temperature of up to 41°C, a slight cough, no sputum, and a large amount of urine. He was given “glucose, azithromycin” and other infusions, but the effect was poor. At 1 p.m., he became comatose and had two convulsions, each lasting tens of minutes. Her husband and sister had a history of diabetes mellitus and cerebral infarction. Physical examination: T37.5°C P100 times/min R20 times/min BP140/100mmhg Weight: 80kg Deep coma, dry skin with poor elasticity, small amount of wet rales at the base of the right lung, no edema in both lower limbs, low muscle tone in the limbs, bilateral pathology(-) Auxiliary examination: blood WBC9.3×109/L N80.1% erythrocyte pressure volume 43.4% RBC4.5×109/L CT showed multiple softening foci, cerebral atrophy. ECG showed sinus tachycardia, II. III, V3-V5 ST-segment depression, and T-wave inversion. Blood biochemistry K5.2 mmol/L Na152 mmol/L Cl116 mmol/L BUN22.6 mmol/L Cr260 umol/L blood glucose 25 mmol/L (emergency biochemistry range <25 mmol/L〉 end blood glucose Hi. Blood PH 7.150. Diagnosis: diabetic hyperosmolar coma sequelae of cerebral infarction primary hypertension Treatment: After admission, the gastric tube was opened and a subclavian vein was placed, NS250 intragastric insulin 20U 6-10U/hour was administered with boiled water and monitored. Blood glucose q15 minutes are Hi, consider the existence of insulin resistance, gradually increase the insulin dosage to 200U/hour, until 8:00 on the 26th total rehydration 8000 insulin 1810U, rehydration alkaline 250ml urine volume 1400ml central venous pressure 6-10mmH2O end blood glucose always Hi, at 8:00 measured intravenous blood glucose 48. 1mmol/L (Japan Hitachi 7180 biochemical instrument) to give Novaline R intravenous 100U. The blood glucose remained high even after the administration of Novolin R 100U/hour. Considering that the patient had been in coma for a long time, it was difficult to control the blood glucose, so at 13:30 on the 26th, the intravenous blood glucose was measured at 45.3 mmol/L and hemodialysis was given for 2 hours. drip during dialysis to prevent a rapid drop in blood glucose. After dialysis, the patient was given 2-4 g of sugar/1U of insulin intravenous drip to maintain the volume, electrolyte and acid-base balance, and the blood glucose was controlled at about 10 mmol/L-13 mmol/L. At 19:00 on the 26th, the patient became clear and ate on his own, and was given Novolin subcutaneously, and the blood glucose was controlled at about 8 mmol/L-10 mmol/L. The condition improved and was discharged on May 1. Discussion: Diabetic hyperosmolar coma is an acute complication of diabetes with high clinical mortality, mostly occurring in elderly patients with type 2 diabetes. [1] The patient had a history of polyphagia and a family history, although he had no history of diabetes. The patient had precipitating factors such as infection, glucose infusion, and low food intake before the onset of the disease, and rapidly developed coma. The combination of history, physical examination, and laboratory tests met the diagnostic criteria for diabetic hyperosmolar coma. [2] Diabetic hyperosmolar coma is usually treated by continuous intravenous drip of low-dose insulin at a rate of 2-12 U/hr. For a few patients with insulin resistance, high-dose insulin therapy can be considered, more than 200 U in 24 hours. [3] It has been reported that 525 U of insulin was applied in 16 hours. [4] In this case, 1810 U of insulin was applied in 13 hours, considering that infection and stress lead to increased glucagon causing insulin resistance, and insulin resistance during stress may be more important than insulin deficiency. [5] Coma 24 hours glucose from high, give hemodialysis effect is better. There are no reports of hemodialysis for intractable hyperglycemia, so if you encounter this situation, you may want to give it a try.