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Coma In Diabetic Patient
 

Coma In Diabetic Patient

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    Coma In Diabetic Patient Coma In Diabetic Patient Presentation Transcript

    • 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