What is Hyperglycemic (Diabetic) Coma?
Hyperglycemic (diabetic) coma is a relatively slowly developing condition associated with an increase in blood glucose levels in diabetes mellitus and the accumulation of toxic conversion products
Causes of Hyperglycemic (Diabetic) Coma
- Uncontrolled treatment of diabetes with insufficient administration of insulin.
- Refusal to use insulin.
- At the beginning of diabetes mellitus, when the patient does not even know about his disease at all, before a diagnosis is made, as a rule, diabetic (hyperglycemic) coma begins to develop.
- Various nutritional errors, injuries and infectious diseases can trigger the development of diabetic (hyperglycemic) coma in patients with diabetes mellitus.
- It occurs when diabetes mellitus takes a long time with little symptoms and the patient does not receive insulin or receives small doses.
Symptoms of Hyperglycemic (Diabetic) Coma
Increasing weakness, thirst, loss of appetite, frequent urination, drowsiness, redness of the skin, rapid breathing – at the initial stage.
Then – loss of consciousness, loss of skin sensitivity, possible twitching of the extremities, convulsions, lowering the tone of the eyeballs (the eyeball is “soft” when pressed), low blood pressure, the smell of acetone during breathing.
This symptom may progress to death.
Treatment of Hyperglycemic (Diabetic) Coma
Precomatose and comatose state of patients with diabetes mellitus requires their urgent hospitalization. Complex treatment of coma includes the restoration of insulin deficiency, the fight against dehydration, acidosis, loss of electrolytes. In the initial stage of diabetic coma, you must first enter insulin. Introduce only crystalline (simple) insulin and in any case, not drugs with prolonged action. Insulin dosage is calculated depending on the depth of the coma. With a mild coma injected 100 IU, with severe coma – 120-160 IU and with deep – 200 IU of insulin. In connection with impaired peripheral blood circulation during the development of cardiovascular insufficiency in the period of diabetic coma, the absorption of injected drugs from the subcutaneous tissue slows down, therefore half of the first insulin dose should be administered intravenously in a stream of 20 ml of isotonic sodium chloride solution. Elderly patients. It is advisable to introduce no more than 50-100 IU of insulin due to the risk of coronary insufficiency. In the precoma injected half the full dose of insulin.
Subsequently, insulin is administered every 2 hours. The dose is selected depending on the level of blood glucose. If after 2 h the glucose content in the blood has increased, then the dose of insulin injected is doubled. The total amount of insulin given in diabetic coma ranges from 400 to 1000 units per day. Along with insulin, glucose should be injected, which has anti-ketogenic effect. It is recommended to begin the introduction of glucose after its level in the blood under the influence of insulin begins to fall. Enter 5% glucose solution intravenously. To restore the lost fluid and electrolytes, 1-2 liters per hour of an isotonic solution of sodium chloride in combination with 15-20 ml of a 10% solution of potassium chloride heated to body temperature are injected intravenously. In total, 5-6 liters of fluid are administered per day; patients older than 60 years, as well as in the presence of cardiovascular failure – no more than 2-3 liters. To combat metabolic acidosis, 200-400 ml of 4-8% solution of freshly prepared sodium bicarbonate is injected intravenously, which cannot be mixed with other solutions. Intravenous administration of 100-200 mg of cocarboxylase, 3-5 ml of 5% ascorbic acid solution is shown. To restore hemodynamic disorders, cardiac glycosides are prescribed (1 ml of a 0.06% Korglikon solution intravenously), 1-2 ml of a 20% caffeine solution or 2 ml of Cordiamine are injected subcutaneously or intravenously.