Temporary lens opacities in diabetic coma were noted by Lawrence, Oakley, and Barne (1942) and thought to be common if the lens was carefully examined. This does not appear to have been frequently discussed, but Sheldon and Pyke (i 968) showed pictures of opacities in the lens of a girl aged Io years, which cleared rapidly with treatment of the diabetic coma. Neuberg, Griscom, and Burns (1958) found only six documented case reports to show acute development and complete reversal of diabetic cataracts and four cases in which the development was unknown but clearing occurred completely.Because only Lawrence and others (1942) noticed complete opacification of the lens in diabetic coma, we thought it valuable to report this case of transient complete opacification of both lenses, complicating hyperosmolar, hyperglycaemic, hypernatraemic coma in a diabetic child of nearly 4 years old; this type of diabetic coma is rare in childhood (McCurdy, I970).
Case reportThis normal baby girl was first admitted soon after her second birthday with diabetic precoma. After rehydration, she was stabilized on a diet containing I I0 g. carbohydrate and 8 units of soluble insulin in the morning and 4 units at night.One month before her 4th birthday she was re-admitted with a history of "strange behaviour", anorexia, polyuria, polydipsia, and misery, but without diarrhoea or vomiting, which had been present for I week.
ExaminationShe was very confused, agitated, unco-operative, and unresponsive, but moving all four limbs. The eyes were sunken and the tongue dry and furred, but the elasticity of the skin was not abnormal. The plantar reflexes were extensor but no localizing neurological signs were noted. The fundi and lenses were normal. Blood pressure 100/75 mm. Hg; pulse rate i6o/min. with a poor pulse volume; respiration 40/min., but not typically acidotic.
Laboratory examinationPlasma urea 136 mg./Ioo ml.; plasma sodium i68 mEq/l.; plasma potassium 4-0 mEq/l.; plasma chloride 133 mEq/l.; plasma bicarbonate i6 mEq/l.; true blood glucose 2,ooo mg./Ioo ml.; plasma ketones present but not measured. Urine contained 2 per cent. glucose and ketones + +.Lumbar puncture normal apart from 300 mg./IOO ml. sugar. Her weight was I5 i kg., which was i i kg. more than the weight recorded in the out-patients department 2 weeks earlier.