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Coma In Diabetic Patient

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Coma In Diabetic Patient

  1. 1. Sarah Aliah Ilham 2006 2005 02 Coma in diabetic patient
  2. 4. Diabetic coma <ul><li>Also known as hyperglycemic hyperosmolar nonketotic syndrome </li></ul><ul><li>serious complication that can happen to a person with type 2 diabetes who is ill or stressed </li></ul><ul><li>diabetic coma occurs most often among people who are older than 60. </li></ul><ul><li>Most sufferers have a history of diabetes, but for some, the disease is undiagnosed or untreated. </li></ul>
  3. 5. <ul><li>blood sugar gets too high and the body becomes severely dehydrated. </li></ul><ul><li>No ketone formed </li></ul><ul><li>Death rate – 50% </li></ul>
  4. 6. <ul><li>What Are the Early Symptoms of Diabetic Coma? </li></ul><ul><li>Early symptoms that may lead to diabetic coma if not treated include: </li></ul><ul><li>Increased thirst </li></ul><ul><li>Increased urination </li></ul><ul><li>Weakness </li></ul><ul><li>Drowsiness </li></ul><ul><li>Altered mental state </li></ul><ul><li>Headache </li></ul><ul><li>Restlessness </li></ul><ul><li>Inability to speak </li></ul><ul><li>Paralysis </li></ul>
  5. 7. Investigation <ul><li>Plasma glucose </li></ul><ul><li>ABG </li></ul><ul><li>Urea and electrolyte </li></ul><ul><li>ECG </li></ul><ul><li>CXR </li></ul><ul><li>Urinanalysis, culture and microscopic examination </li></ul><ul><li>* calculate plasma osmolality </li></ul><ul><ul><li>2 x (Na + K) + glucose </li></ul></ul><ul><ul><li>285 – 295 mOsmol/Kg </li></ul></ul><ul><ul><li>Coma = > 400 mOsmol/Kg </li></ul></ul>
  6. 8. Management <ul><li>Aim: </li></ul><ul><ul><li>To correct the high osmolality with fluid and insulin over 48-72 hours </li></ul></ul><ul><ul><li>Avoid fluid overload (central venous line) </li></ul></ul>
  7. 9. Management <ul><li>Manage as for DKA except: </li></ul><ul><ul><li>Initial resuscitation with colloid </li></ul></ul><ul><ul><li>0.9% saline for fluid replacement </li></ul></ul><ul><ul><li>If [Na+] is > 150 mmol/L, use 5% dextrose </li></ul></ul><ul><ul><li>Slow correction of Na </li></ul></ul><ul><ul><li>Start insulin at 3 U/hr </li></ul></ul><ul><ul><li>Anticoagulate </li></ul></ul>
  8. 10. <ul><li>CBD if </li></ul><ul><ul><li>Serum creatinine is high </li></ul></ul><ul><ul><li>Oliguria </li></ul></ul><ul><li>When blood glucose is <10 mmol/L – 5% dextrose </li></ul><ul><li>Stabilized - stop insulin therapy, start OHA or diet control </li></ul>
  9. 11. Hypoglycemic coma <ul><li>Dxt </li></ul><ul><li>Management : </li></ul><ul><li>75 ml 20% glucose IV or 1mg glucagon IM </li></ul><ul><li>Once recovered give bread or biscuits </li></ul><ul><ul><ul><li>Should regain consciousness within 10 minutes </li></ul></ul></ul><ul><ul><ul><li>If not repeat blood glucose and consider other cause of coma </li></ul></ul></ul><ul><ul><ul><ul><li>Alcohol intox. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Post ictal state </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Cerebral hemorrhage </li></ul></ul></ul></ul><ul><ul><ul><li>Consider cerebral edema after blood glucose is restored to normal </li></ul></ul></ul>
  10. 12. <ul><li>Admit if the cause is long –acting SU or long acting insulin </li></ul><ul><ul><ul><li>Continuous infusion of 10% dextrose (1L / 8hrly) </li></ul></ul></ul><ul><ul><ul><li>Check glucose hourly </li></ul></ul></ul>

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