A case of inaugural hyperosmolar diabetic coma reported from Côte d’Ivoire

A forty eight years old man was brought into the hospital in a deeply comatose and dehydrated state. In Côte d'Ivoire, few works related to hyperosmolar hyperglycemic syndrome state have been carried out from different teams but all of them have been made in Abidjan. This case we reported, diagnosed in the centre of the Côte d'Ivoire. Patient referred from a private hospital in a fever context with fasting glycemia at 101.95mmol/l. The onset of symptomatology began one week before his admission by general pains and headache. One day before admission, occurred a weak of conscious such as coma that motivated his admission in hospital. In order to get a good therapy, he has been evacuated in the medical school of Bouaké. At admission, we notified severe hyperglycemia 101.95 mmol/l associated with hyperuremia at 2.75g/l, hypercreatininemia at 125.5mg/l, massive glycosuria and only just a weak presence of ketonuria. Related to electrolytes, exams showed: hypokaliemia (3.30mEq/l) and normal value of natremia (143mEq/l). These values permitted us to calculate osmolality which was estimated to 440.41mosm/l. On the basis of the laboratory results and clinical examination, the diagnosis of hyperglycemic and hyperosmolar syndrome was confirmed. Moreover, fever at 39°C could be the primum movens of this complication and as well as a sign of infectious complications. Probably originate from lung and inherent to this disease. Rapidly fatal evolution of this case don't allow us to lead other investigations precisely X-ray; although infectious syndrome seemed to be the case of the triggering of the hyperosmolar hyperglycemic state (HHS).