Sarah Aliah Ilham 2006 2005 02

Coma in diabetic patient

Diabetic comaAlso known as hyperglycemic hyperosmolar

nonketotic 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

Death rate – 50%

What Are the Early Symptoms of Diabetic Coma?

Early symptoms that may lead to diabetic coma if not treated include:

Increased thirstIncreased urinationWeaknessDrowsinessAltered mental stateHeadacheRestlessnessInability to speakParalysis

Investigation Plasma glucoseABGUrea and electrolyteECGCXRUrinanalysis, culture and microscopic

examination

* calculate plasma osmolality2 x (Na + K) + glucose 285 – 295 mOsmol/KgComa = > 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 colloid0.9% saline for fluid replacementIf [Na+] is > 150 mmol/L, use 5% dextroseSlow correction of NaStart insulin at 3 U/hrAnticoagulate

CBD ifSerum creatinine is highOliguria

When blood glucose is <10 mmol/L – 5% dextrose

Stabilized - stop insulin therapy, start OHA or diet control

Hypoglycemic comaDxt

Management :75 ml 20% glucose IV or 1mg glucagon IMOnce recovered give bread or biscuits

Should regain consciousness within 10 minutesIf not repeat blood glucose and consider other cause of

comaAlcohol intox.Post ictal state Cerebral hemorrhage

Consider cerebral edema after blood glucose is restored to normal

Admit if the cause is long –acting SU or long acting insulin

Continuous infusion of 10% dextrose (1L / 8hrly) Check glucose hourly