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Vacuolated Erythroblasts in Hyperosmolar Coma

Daniel E. Lehane, MD
Arch Intern Med. 1974;134(4):763-765. doi:10.1001/archinte.1974.00320220165025.
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Vacuolated erythroblasts have been found in several seemingly unrelated clinical situations, the most common being chloramphenicol toxicity. This report describes morphologically similar vacuolization in association with hyperglycemic, nonketotic, hyperosmolar coma. This patient was seen on two separate occasions with this syndrome and both times the bone marrow showed vacuolated erythroblasts that improved when hyperglycemia and hyperosmolality were controlled.

Patient Summary  A 17-year-old high school student was admitted on two occasions to the Buffalo General Hospital for hyperglycemic, nonketotic, hyperosmolar coma. At age 4 years he had a viral encephalitis following which he became hyperphagic and rapidly gained weight. At age 9 years he was 140 cm (55.1 in) tall and weighed 135 kg (298 lb), and at age 15 years he was 145 cm (57 in) tall and weighed 151 kg (333 lb).His first admission in March 1967 was preceded by a three-week history of dizziness, headache, sore throat,


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