The document discusses different types of diabetic comas including hypoglycemic coma, diabetic ketoacidosis, hyperglycemic hyperosmolar state, and lactic acidosis. It provides diagnostic criteria for each condition including specific ranges for blood pH, serum bicarbonate, ketones, glucose, osmolality, and anion gap. Diabetic ketoacidosis is associated with severe insulin deficiency and hyperglycemia over 250 mg/dL while hyperglycemic hyperosmolar state involves hyperglycemia over 600 mg/dL without acidosis. Lactic acidosis presents with severe acidosis, elevated lactate, and absent ketones.

1. DIABETIC COMA

2. • Coma may be due to a variety of causes not directly related
to diabètes.
• Certain causes directly related to diabetes require
differentiation:
• (1) Hyp glycemia resulting from excessive doses of insulin or
oral hypoglycemic agents.
• 2) Hyperglycemic coma associated with either severe insulin
deficiency (diabetic ketoacidosis) or mild to moderate insulin
deficiency (hyperglycemic hyperosmolar state)
• 3) Lactic acidosis associated with diabetes,

3. DIABETIC KETOACIDOSIS
• Hyperglycemia greater than 250 mg/dL
• » Acidosis with blood pH < 7.3.
• » Serum bicarbonate less than 15 mEq/L.
• » Serum positive for ketones.

4. HYPERGLYCEMIC HYPEROSMOLAR STATE
• » Hyperglycemia greater than 600
• » No acidosis; blood pH > 7.3.
• » Serum bicarbonate greater than 15 mEq/L.
• » Serum osmolality greater than 310mOsm/kg.
• » Normal anion gap (less than 14 mEq/L).

5. LACTIC ACIDOSIS
• » Severe acidosis with hyperventilation.
• » Blood pH below 7.30.
• » Serum bicarbonate less than 15 mEq/L.
• » Anion gap greater than 15 mEq/L.
• » Serum lactate greater than 5 mmol/L.
• » Absent serum ketones.

6. Hyperglycemic coma
• Individuals with type 1 or type 2 DM and severe
hyperglycemia [300 mg/dL] ) should be assessed for
clinical stability; including mentation and hydration.
• the patient is stable or if diabetic ketoacidosis or a
hyperglycemic hyperosmolar state should be
considered.
• Ketones，an indicator of diabetic ketoacidosis,
should be measured in individuals with type 1 DM
when the plasm glucose is > (300 mg/dL) ， during a
concurrent illness， or with symptoms such as
nausea， vomiting， or abdominal pain.
• Blood measurement of ß-ydroxybutarrate is
preferred over urine

7. • DKA was formerly considered a hallmark of
type 1 DM,
• HHS is primarily seen in individuals with type 2
DM,
• Both disorders are associated with absolute or
relative insulin deficiency, volume depletion
and acid base abnormalities,

8. DIABETlC KETOACI DOSIS