Diabetes mellitus and hyperglycemic coma are inextricably linked. The latter is observed in violation of metabolism during the course of the first disease. Often a person does not even suspect that he has diabetes mellitus, and learns about this diagnosis only after being in the hospital after losing consciousness. Competent and timely assistance is needed to save the patient's life.
The concept of hyperglycemia
If the body can not cope with the utilization of glucose, then its concentration in the blood increases sharply. This leads to hyperglycemia, which has 3 stages of manifestation:
- mild - glucose concentration - less than 10 mmol/l;
- medium - 10-16;
- heavy - more than 16 mmol/l.
If the sugar level at the last stage is not stabilized at an acceptable level, the patient may develop hyperglycemiccoma.
During the course of diabetes, hyperglycemia becomes chronic, in the case of an insulin-dependent form it is determined by a lack of exogenous insulin. In patients with this type 2 disease, glucose accumulates in the blood due to a decrease in the sensitivity of tissues to this substance, as well as due to insufficient production of it by the body itself.
Classification
For the reason that leads to the development of a coma, its forms are distinguished as:
- ketoacidotic - occurs when the acid-base balance in the body is disturbed;
- hyperlactacidemic - occurs due to the accumulation of a large mass fraction of lactic acid in the tissues;
- hyperosmolar - noted in violation of water-electrolyte metabolism observed in the patient's body.
For adults, the latter form is more common, and for children, the first.
Causes of disease
Elevated blood glucose can be caused by the following:
- stress;
- taking certain medications: corticosteroids, beta-blockers, antidepressants;
- heavy consumption of carbohydrates with meals;
- disturbances in the administration of insulin in the first type of diabetes mellitus. (hyperglycemic coma in this case has a high risk of occurrence).
Such situations include the following:
- drug replacement;
- poor-quality drug;
- Wrong dose;
- skipping an injection.
When stressed, the body breaks down the stored carbohydrate glycogen into glucose. These include the following states:
- inflammatory processes;
- infectious diseases;
- pregnancy and childbirth;
- physical overload;
- emotional overstrain;
- fasting lasting more than 8 hours.
In a he althy person, sugar spikes are observed during the day after eating sweet foods, but they do not pose a danger to him. Allocate, in addition to hyperglycemic, and hypoglycemic coma. Both the one and the other in patients with type 2 diabetes are less common compared to the insulin-dependent form. It can be mainly caused by the following factors:
- damage to the pancreas causing suppression of the body's insulin production;
- violation of the diet;
- stop sugar-lowering drugs.
Hyperglycemic coma can lead to the intake of alcoholic beverages by patients with diabetes mellitus. Previous strokes and heart attacks also contribute to its appearance.
The following conditions lead to hyperosmolar syndrome:
- taking certain medications;
- hypothermia, heat stroke and some other physical effects;
- surgeries and various injuries;
- endocrinological diseases;
- peritoneal dialysis, renal failure;
- extensive bleeding;
- major burns;
- stroke;
- intestinal obstruction;
- acute form of pancreatitis;
- pulmonary embolism;
- myocardial infarction;
- infections with diarrhea, vomiting and fever.
Clinical picture
The disease does not develop all at once, but over a period of time, which can range from several hours to days. During the course of this process, the patient can reveal the manifestation of signs of hyperglycemic coma. If appropriate measures are not taken, a state of precoma occurs, after which the person will go into an unconscious state. If he stays in it for more than a day without medical assistance, there is a high probability of a fatal outcome.
The main differences between hypo- and hyperglycemic coma are that the first one mainly comes on suddenly and is accompanied by cold sticky sweat, loss of consciousness, and in severe cases - convulsions, and the second comes gradually, the person feels weakness, from the mouth there is a smell of acetone (ketonemia, absent in the hyperosmolar form), the skin becomes dry, there is also dryness in the mouth.
As noted earlier, hyperglycemic coma is rare in patients with type 2 diabetes. It also rarely develops in older diabetics. Children and teenagers are at the highest risk.
Symptoms of hyperglycemic coma
At the beginning of the body falling into this statethe following symptoms appear:
- intensified thirst that does not disappear;
- urination increases;
- nausea, vomiting, abdominal discomfort;
- headache;
- weakness;
- dry epidermis;
- facial redness;
- reduced muscle tone.
Precoma is characterized by the following features:
- noisy breathing with the smell of acetone;
- tachycardia;
- decrease in body temperature;
- decrease in blood pressure;
- constipation or diarrhea;
- cessation of urination.
In a person who falls into a coma, the turgor of the eyeballs decreases. This is easily manifested by the sensations of pressing on it in a he althy person and a patient. In case of violation of the biochemical parameters of the blood, the patient's condition deteriorates sharply. He becomes capricious, irritable, there are complaints of pain in the abdomen. In this case, the symptoms are similar to those observed with peritonitis, and therefore this symptom was called "false acute abdomen". In the hyperosmolar form, ketoacidosis is absent. The disease begins abruptly, the volume of blood that circulates through the vessels quickly decreases. The hyperlactacid form is characterized by pain in the abdomen, behind the sternum and in the region of the heart, nausea, diarrhea, vomiting, and drowsiness. It is more typical for older people. It can be provoked not only by diabetes mellitus, but also by alcohol dependence, pathologies of the kidneys and liver.
In hyperosmolar syndrome, there is a lesion of the nervoussystems. In this case, the following symptoms are recorded:
- paresis or paralysis of muscle groups;
- rapid involuntary movements of the eyeballs;
- speech disorders;
- convulsions;
- other neurological symptoms.
These symptoms indicate that a coma is approaching.
Diagnosis
Identification of the disease is carried out by analysis of urine and blood. Below are indicators determined in urine:
- protein, red blood cells, sugar content;
- mass fraction of creatinine, urea and residual nitrogen is significantly higher than normal;
- ketone bodies are abundant;
- specific gravity of urine is greater than that of a he althy person.
The following signs are characteristic of blood:
- neutrophilia, elevated hemoglobin, red blood cell count, ESR;
- increased residual nitrogen content;
- sugar exceeds 16.5 mmol/l.
Fundus examination reveals signs of retinopathy. Cerebrospinal fluid shows increased blood pressure and increased sugar levels.
When providing emergency care for hyperglycemic coma in pre-coma and comatose states, insulin should be injected. In hypoglycemic coma, glucose is administered. A mistake can cost a person their life. The main differences between them are manifested by the presence of acetone in the urine (in the first case they are present, in the second trace amounts may be noted), the presence of appetite (in the hyperglycemic form it is absent, inwhile with hypoglycemic - there is; established by a survey of relatives), muscle tone (reduced and increased, respectively), pulse (accelerated and slow).
With hyperosmolar syndrome, blood clotting is often impaired, so blood tests for APTT and prothrombin time are needed.
Emergency care for hyperglycemic coma
During a pre-coma state, do the following:
- give the patient alkaline mineral water;
- preparations of potassium and magnesium - the first in a larger dose is administered for hyperosmolar syndrome;
- limit carbohydrate foods;
- inject short insulin every 2-3 hours under the skin with blood sugar control;
- put him to bed by removing annoying factors.
If the patient's condition has not improved or, on the contrary, worsened, you need to call an ambulance.
Algorithm for hyperglycemic coma:
- put the person on their side to prevent vomit from entering the respiratory tract;
- if there are dentures in the mouth, remove them from there;
- watch the tongue that shouldn't fall;
- measure sugar levels;
- inject insulin;
- call medics;
- monitor your pulse and breathing.
The ambulance team that arrived needs to be told in detail what preceded the attack.
Principles of emergency care:
- the patient should not be left to himself;
- need an ambulancecause even if the person's condition has improved;
- when he is in an adequate condition, you cannot forbid him to inject insulin on his own.
When falling into a coma, the patient is transported to the hospital. The duration of his stay in this institution is determined by the severity of the condition.
Thus, following this algorithm of emergency care for hyperglycemic coma, you can save the life of the patient.
Inpatient treatment
In order to maintain the he alth of the patient, it is necessary to start therapy in a medical institution as soon as possible.
Help for glycemic coma in a hospital setting is as follows:
- treatment of comorbidities;
- correction of metabolic acidosis;
- electrolyte imbalance;
- fight against insulin deficiency and dehydration.
Treatment regimen:
- injection of insulin in small doses intravenously until the signs of coma disappear, blood and urine tests are taken every 2-3 hours to control the content of sugar and acetone;
- to “burn out” ketone bodies, one hour after insulin administration, glucose is injected (up to 5 times a day);
- to combat acidosis and maintain vascular tone, physiological saline and intravenous s alt solution are administered;
- to speed up the redox reactions occurring in the body, the patient is given an oxygen cushion and heating pads are applied to the limbs;
- cardiac activity is supported by the introduction of camphor, caffeine, vitamins C, B1, B2.
In the hyperosmolar form, the sugar level should not fall by more than 5.5 mmol/l per hour. In this case, the density of blood serum should decrease by less than 10 mosmol/l per hour. Dehydration is removed with a 2% glucose solution when the concentration of sodium ions in the plasma is more than 165 meq / l, at a lower concentration a solution of sodium chloride is administered.
After the patient wakes up from a coma, the interval between insulin injections increases and the dose decreases. The patient should consume a large amount of liquid: juices, fruit drinks, sweet tea, compotes, Borjomi. Oatmeal and rice porridge are introduced into his diet, and the use of fat-containing foods is limited. The transition to the usual dose of insulin is gradual.
Forecast
Coma caused by diabetes does not pass without a trace. There is energy hunger in the body. The longer the course of the coma, the more severe the consequences for the body.
Sometimes a hyperglycemic coma can last several months.
As a result of this, the following types of violations may occur:
- kidney work;
- heart;
- appearance of slurred speech;
- paresis of limbs;
- uncoordinated movements.
Children who have been in this state may have mental disorders. Pregnant women have a high chance of losing a baby.
Full recovery of a person who has undergone a coma is possible with a properly organized rehabilitationperiod. In this case, it is necessary to strictly adhere to the prescriptions of doctors regarding:
- taking vitamin complexes and sugar-lowering agents;
- meditation, playing sports, giving up bad habits;
- following a diet;
- maintain insulin doses and control sugar levels.
The considered coma can be complicated by an excess concentration of lactic acid in the blood. This dramatically worsens the prognosis of treatment. Therefore, you need to measure the level of lactic acid in the blood.
Prevention
In order to prevent hyperglycemic coma in diabetes mellitus, you need to follow simple rules:
- giving up bad habits;
- not starting infections;
- do not overexert yourself with physical activity;
- avoid stress;
- do not use expired insulin;
- stay on your insulin schedule;
- monitor glucose levels;
- diet;
- In case of threatening signs, you need to seek emergency help.
Diabetes can occur in anyone. Therefore, you need to periodically check the level of glucose in the blood, if you find the limits, you need to consult an endocrinologist.
In conclusion
Diabetes mellitus and a number of other diseases may be accompanied by the appearance of hyperglycemic coma. Emergency care must be provided by relatives before the ambulance arrives. The highest risk forThis condition is typical for patients with diabetes mellitus, mainly type 1. Therefore, it is necessary to monitor the level of glucose in the blood and urine, inject insulin on time and in the required doses, and follow the diet recommended for this disease. For children, the ketoacidosis form is mainly characteristic, accompanied by a characteristic smell of acetone from the mouth, and for adults, hyperosmolar syndrome, in which it is not felt and which can be caused not only by diabetes mellitus, but also by other diseases. When falling into a coma, the work of all organs and systems of the body is disrupted, therefore, to avoid the most severe consequences and quickly eliminate this condition, you need to consult a doctor.
