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Coma In Diabetic Patient

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Coma In Diabetic Patient

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

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