Diabetes mellitus and hyperglycemic coma are inextricably linked. The latter is observed in metabolic disorders during the course of the first ailment. Often a person does not even suspect that he has diabetes, and finds out about this diagnosis only when he is in the hospital after losing consciousness. To save the patient’s life, competent and timely assistance is needed.
The concept of hyperglycemia
If the body does 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:
- light - glucose concentration - less than 10 mmol / l;
- average - 10-16;
- heavy - more than 16 mmol / l.
With unstable sugar levels in the last stage at an acceptable level, the patient may develop hyperglycemic coma.
During the course of diabetes, hyperglycemia becomes chronic, in the case of an insulin-dependent form, it is determined by the 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 by the body itself.
Classification
For the reason that leads to the development of a coma, its forms are distinguished, such as:
- ketoacidotic - occurs when the acid-base balance is disturbed in the body;
- hyperlactacidemic - occurs due to the accumulation in the tissues of a large mass fraction of lactic acid;
- hyperosmolar - is noted in violation of the water-electrolyte metabolism observed in the patient’s body.
For adults, the latter form is more common, and for children, the first.
Causes of the disease
An increased concentration of glucose in the blood can be caused by the following:
- stress
- taking certain drugs: corticosteroids, beta-blockers, antidepressants;
- a large amount of carbohydrates consumed during 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).
These situations include the following:
- drug replacement;
- low-quality drug;
- improperly selected dose;
- skipping an injection.
Under stress, the body breaks down the glycogen storage carbohydrate to glucose. These include the following conditions:
- inflammatory processes;
- infectious diseases;
- pregnancy and childbirth;
- physical overload;
- emotional overstrain;
- fasting lasting more than 8 hours.
In a healthy person, sugar jumps are observed during the day after eating sweet food, but they do not pose a danger to him. Allocate, in addition to hyperglycemic, and hypoglycemic coma. Both of these are less common in patients with type 2 diabetes mellitus compared to the insulin-dependent form. Basically, it can be caused by the following factors:
- damage to the pancreas, causing a suppression of the production of insulin by the body;
- violation of the diet;
- discontinuation of sugar-lowering drugs.
A hyperglycemic coma can be caused by the intake of alcoholic beverages by patients with diabetes mellitus. Contribute to its appearance and previous strokes and heart attacks.
The following conditions lead to hyperosmolar syndrome:
- taking certain medications;
- hypothermia, heat stroke and some other physical effects;
- operations and various injuries;
- endocrinological diseases;
- peritonial dialysis, renal failure;
- extensive bleeding;
- large burns;
- stroke;
- intestinal obstruction;
- acute form of pancreatitis;
- pulmonary embolism;
- myocardial infarction;
- infections accompanied by diarrhea, vomiting and fever.
Clinical picture
The disease does not develop simultaneously, but over a period of time, which can range from several hours to days. During the course of this process, the patient can reveal signs of hyperglycemic coma. If appropriate measures are not taken, the state of precoma sets in, after which the person goes into an unconscious state. If he will be in it for more than a day without medical assistance, the probability of a fatal outcome is high.
The main differences between hypo- and hyperglycemic coma are that the first mainly comes on suddenly and is accompanied by cold, sticky sweat, loss of consciousness, and in severe cases, cramps, and the second comes gradually, the person feels weak, the smell of acetone is felt from the mouth (ketonemia , with a hyperosmolar form is absent), the skin becomes dry, dry mouth is also present.
As noted earlier, the hyperglycemic form of coma is rare in patients with type 2 diabetes. It also rarely develops in elderly diabetics. At risk are children and adolescents.
Symptoms of hyperglycemic coma
At the beginning of the body's fall into this state, the following symptoms appear:
- increased thirst that does not disappear;
- urination increases;
- nausea, vomiting, discomfort in the abdomen;
- headache;
- weakness;
- dryness of the epidermis;
- facial redness;
- decreased muscle tone.
Precoma is characterized by the following symptoms:
- noisy breath with the smell of acetone;
- tachycardia;
- decrease in body temperature;
- decrease in blood pressure;
- constipation or diarrhea;
- stop urinating.
In a person falling into a coma, the turgor of the eyeballs decreases. This is easily manifested by the sensations of pressure on him in a healthy person and patient. In case of violation of biochemical parameters of blood, the patient's condition worsens sharply. He becomes moody, irritable, complaints about abdominal pain appear. In this case, the symptoms are similar to those observed with peritonitis, and therefore this symptom is called "false acute abdomen." With the hyperosmolar form, ketoacidosis is absent. The disease begins abruptly, the volume of blood that circulates through the vessels decreases rapidly. The hyperlactacid form is characterized by the presence of pain in the abdomen, behind the sternum and in the heart, nausea, diarrhea, vomiting, and drowsiness. It is more characteristic of older people. It can provoke not only diabetes, but also alcohol dependence, pathology of the kidneys and liver.
With hyperosmolar syndrome, damage to the nervous system is noted. In this case, the following symptoms are recorded:
- paresis or paralysis of muscle groups;
- rapid involuntary movements of the eyeballs;
- speech impairment;
- cramps
- other neurological symptoms.
These symptoms indicate that a coma is approaching.
Diagnostics
The detection of the disease is carried out by analysis of urine and blood. The following are indicators determined in the urine:
- the content of protein, red blood cells, sugar;
- the mass fraction of creatinine, urea and residual nitrogen is much higher than normal;
- ketone bodies are represented in large numbers;
- the specific gravity of urine is greater than that of a healthy person.
The following symptoms are characteristic of blood:
- neutrophilia, elevated hemoglobin, the number of red blood cells, ESR;
- increased content of residual nitrogen;
- sugar exceeds 16.5 mmol / l.
Examination of the fundus reveals signs of retinopathy. In the cerebrospinal fluid, an increased pressure and an increased concentration of sugar are detected.
When providing emergency care for hyperglycemic coma in precomatous and coma, you need to inject insulin. With hypoglycemic coma, glucose is administered. A mistake can cost a person 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 (with a hyperglycemic form, it is not, while with a hypoglycemic form it is; they are established by a survey of relatives), muscle tone (lowered and increased, respectively), pulse (rapid and slow).
With hyperosmolar syndrome, blood coagulation is often impaired, therefore, blood tests for APTT and prothrombin time are needed.
Emergency care for hyperglycemic coma
During a precomatous state, the following actions must be performed:
- give the patient alkaline mineral water;
- potassium and magnesium preparations - the first in a larger dose is administered in case of hyperosmolar syndrome;
- limit your intake of carbohydrate foods;
- inject short insulin every 2-3 hours under the skin with blood sugar level control;
- put him to bed, removing annoying factors.
If the patient's condition has not improved or, conversely, worsened, an ambulance must be called.
Algorithm for hyperglycemic coma:
- put a person on his side to prevent vomiting from entering the respiratory tract;
- if there are prostheses in the mouth, remove them from there;
- observe a language that should not fall;
- take a sugar level measurement;
- make an injection of insulin;
- call doctors;
- watch your pulse and breath.
The ambulance team that arrived should be told in detail what preceded the attack.
Principles of emergency care:
- the patient should not be left to his own devices;
- an ambulance needs to be called, even if the person’s condition has improved;
- when it is in an adequate state, one cannot forbid him to administer insulin independently.
When falling into a coma, the patient is transported to a hospital. The time of his stay in this institution is determined by the severity of the condition.
Thus, observing this emergency care algorithm for hyperglycemic coma, one can save the patient's life.
Hospital treatment
In order to maintain the health of the patient, you need to start therapy as soon as possible in a medical facility.
Help with a glycemic coma in a hospital is as follows:
- therapy of concomitant disorders;
- correction of metabolic acidosis;
- electrolyte imbalance;
- fight against insulin deficiency and dehydration.
Treatment scheme:
- administering insulin in small doses intravenously until the signs of coma disappear; blood and urine tests are taken every 2-3 hours to monitor the content of sugar and acetone;
- to “burn out” ketone bodies, glucose is administered one hour after the administration of insulin (up to 5 times per day);
- to combat acidosis and maintain vascular tone, physiological saline and intravenous saline are administered;
- to accelerate the redox reactions that occur in the body, the patient is given an oxygen pillow and heaters are applied to the limbs;
- cardiac activity is supported by the introduction of camphor, caffeine, vitamins C, B 1 , B 2 .
With a hyperosmolar form, the sugar level should not decrease 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 at a concentration of sodium ions in the plasma of more than 165 meq / l, at a lower concentration, a solution of sodium chloride is introduced.
After the patient leaves the 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. Oat and rice porridge is introduced into his diet, and the use of fat-containing products is limited. The transition to the usual dose of insulin is gradual.
Forecast
The coma caused by diabetes does not pass unnoticed. The body begins an energy hunger. The longer the coma, the worse the consequences for the body.
Sometimes the course of hyperglycemic coma can last several months.
As a result of this, the following types of violations can be noted:
- kidney work;
- heart
- slurred speech;
- paresis of limbs;
- uncoordinated movements.
Children who have been in this condition may have mental disorders. Pregnant women are more likely to lose a baby.
A full recovery of a person who has suffered a coma is possible with a properly organized rehabilitation period. In this case, it is necessary to strictly adhere to the prescriptions of doctors in relation to:
- intake of vitamin complexes and sugar-lowering agents;
- meditation, sports, giving up bad habits;
- dieting;
- holding doses of insulin and controlling sugar levels.
The coma under consideration can be complicated by an excessive concentration of lactic acid in the blood. This dramatically worsens the prognosis of treatment. Therefore, it is necessary to measure the level of lactic acid in the blood.
Prevention
In order to prevent hyperglycemic coma in diabetes, you need to follow simple rules:
- rejection of bad habits;
- non-infection
- Do not overstrain yourself with physical activity;
- avoid stress;
- do not use expired insulin preparations;
- follow the schedule of insulin therapy;
- monitor glucose levels;
- follow a diet;
- in case of threatening signs, you need to seek emergency help.
Diabetes can occur in any person. Therefore, it is necessary to periodically check the level of glucose in the blood, if limit standards are found, you need to consult an endocrinologist.
Finally
Diabetes mellitus and a number of other diseases can be accompanied by the appearance of hyperglycemic coma. Emergency care must be provided by relatives before the ambulance arrives. The highest risk for this 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, in time and in the required doses, to do insulin injections, follow the diet recommended for this disease. For children, a ketoacidosis form is usually characteristic, accompanied by a characteristic smell of acetone from the mouth, and for adults, a 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 serious consequences and the quick elimination of this condition, you need to consult a doctor.