Coma In Diabetic Patient

Sarah AliahIlham
2006 2005 02
Coma in diabetic patient

Diabetic coma
Also known as hyperglycemic hyperosmolarnonketotic syndrome
serious complication that can happen to a person with type 2 diabetes who is ill or stressed
diabetic coma occurs most often among people who are older than 60.
Most sufferers have a history of diabetes, but for some, the disease is undiagnosed or untreated.

blood sugar gets too high and the body becomes severely dehydrated.
No ketone formed

In most cases, there is a history of excess thirst and urination for weeks prior to diagnosis. Excess urination and extreme elevations of blood sugar levels lead to dehydration throughout the body, including cells becoming dehydrated. The severe loss of body water can lead to shock, coma, and death. Death rates can be as high as 50%.
People who are especially at risk include those who are chronically ill or disabled.

What Are the Early Symptoms of Diabetic Coma?
Early symptoms that may lead to diabetic coma if not treated include:
Increased thirst
Increased urination
Weakness
Drowsiness
Altered mental state
Headache
Restlessness
Inability to speak
Paralysis

Investigation
Plasma glucose
ABG
Urea and electrolyte
ECG
CXR
Urinanalysis, culture and microscopic examination
* calculate plasma osmolality
2 x (Na + K) + glucose
285 – 295 mOsmol/Kg
Coma = > 400 mOsmol/Kg

Management
Aim:
To correct the high osmolality with fluid and insulin over 48-72 hours
Avoid fluid overload (central venous line)

Management
Manage as for DKA except:
Initial resuscitation with colloid
0.9% saline for fluid replacement
If [Na+] is > 150 mmol/L, use 5% dextrose
Slow correction of Na
Start insulin at 3 U/hr
Anticoagulate

CBD if
Serum creatinine is high
Oliguria
When blood glucose is <10 mmol/L – 5% dextrose
Stabilized - stop insulin therapy, start OHA or diet control

Hypoglycemic coma
Dxt
Management :
75 ml 20% glucose IV or 1mg glucagon IM
Once recovered give bread or biscuits
Should regain consciousness within 10 minutes
If not repeat blood glucose and consider other cause of coma
Admit if the cause is long –acting SU or long acting insulin
Continuous infusion of 10% dextrose (1L / 8hrly)
Check glucose hourly