Diabetes complications

Hyperosmolar coma in diabetes mellitus: emergency care, preventive measures and the first signs of approaching danger

Hyperosmolar coma is a most dangerous condition that is characterized by a serious metabolic disorder and develops in diabetes.

Most often, hyperosmolar coma occurs in older people on the background of moderate diabetes.

In more than half of the cases, this condition leads to the death of the patient, so it is necessary to know how emergency treatment is performed with hyperosmolar coma. For this it is necessary to understand the mechanisms of its occurrence and development.

The reasons

The mechanism of development of hyperosmolar coma is not fully understood by scientists until now.

Depending on the species, the key links in the pathogenesis of hyperosmolar diabetic coma are plasma hyperosmolarity and a decrease in brain cell consumption of glucose.

Its development proceeds against the background of a state of hyperosmolarity - the concentration of glucose and sodium in the blood significantly increased compared with the norm, against the background of significant diuresis.

A large number of these highly osmotic compounds, weakly penetrating into the cells of tissues, leads to the appearance of a difference between the pressure inside the cell and in the cell-cell liquid. This leads to the dehydration of cells, especially the brain. If the process develops, there comes a general dehydration.The loss of already 20% of the water contained in the body can be fatal.

A patient with such symptoms needs immediate treatment - then the chances of survival increase significantly.

In addition, microcirculation is disturbed in the brain, and the pressure of the cerebrospinal fluid decreases.

All this leads to serious disruptions in the supply of essential substances to the brain cells, as a result of which collapse and coma develop. It is characteristic that about a quarter of patients who developed hyperosmolar hyperglycemic coma did not know about the problems with the level of glucose in the blood. These people had not been diagnosed with diabetes on time, since before the coma, he did not cause any symptoms that were seriously disturbing the person.

Although hyperosmolar coma pathogenesis is poorly understood, physicians successfully treat patients who have applied at an early stage.

Factors affecting the occurrence of coma

In itself, the presence of diabetes in a patient usually does not lead to the development of hyperosmolar coma. The occurrence of this disease is caused by a complex of causes that negatively affect metabolic processes and lead to dehydration.

Causes of dehydration can be:

  • vomiting;
  • diarrhea;
  • intercurrent illness;
  • weakening of thirst, characteristic of older age;
  • infectious diseases;
  • significant blood loss - for example, during surgery or after injury.

Also common risk factors for hyperosmolar coma are digestive problems caused by pancreatitis or gastritis. Injuries and injuries, myocardial infarction can also cause coma in people with diabetes. Another risk factor is the presence of a disease that occurs with manifestations of fever.

The wrong drug therapy prescribed for the treatment of diabetes mellitus can also be the cause of coma. Especially often this process develops with overdose or individual hypersensitivity, manifested when taking a course of diuretics or glucocorticoids.

Up to a quarter of patients with hyperosmolar coma did not know about their diabetes.

Symptoms of the disease

Hyperosmolar diabetic coma develops quite quickly. It takes several days from the normal state of the body to the pre-housework, and sometimes several hours.

First, the patient begins to suffer from constantly increasing polyuria, accompanied by thirst and general weakness.

Symptoms are aggravated, after a while drowsiness, dehydration appears. A few days later, and with an especially acute course of the disease - and after a few hours, problems with the central nervous system - lethargy and dullness of the reaction. If the patient does not receive the necessary help, these symptoms are aggravated and become comatose.

In addition, there may be hallucinations, increased muscle tone, convulsive uncontrolled movements, areflexia. In some cases, the development of hyperosmolar coma is characterized by an increase in temperature.

Hyperosmolar diabetic coma may also occur with long-term immunosuppressant use by the patient, as well as after some therapeutic procedures.

Hemodialysis, the introduction of sufficiently large quantities of saline solutions, magnesia, and other agents that combat high blood pressure are dangerous.

When hyperosmolar coma is diagnosed pathological changes in the composition of the blood. The amount of glucose and osmolar substances increases significantly, and ketone bodies are not present in the analysis.

Urgent Care

As already mentioned, in the absence of qualified medical care, coma ends in death.

Therefore, it is urgently necessary to provide the patient with qualified medical assistance. Necessary in the case of coma measures are in the intensive care unit or in the emergency room.

The most important task is replenishment of the fluid lost by the body, bringing indicators to a normal level. The fluid in the body is administered intravenously, and in sufficiently large volume.

In the first hour of therapy, administration of up to 1.5 liters of fluid is permissible. Subsequently, the dosage is reduced, but the daily volume of infusions remains very significant. For 24 hours, from 6 to 10 liters of solution is poured into the patient's blood. There are cases when more solution is required, and the volume of injected liquid reaches 20 liters.

The composition of the solution may vary depending on the indicators of laboratory blood tests. The most important of these indicators is the sodium content.

The concentration of this substance in the range of 145-165 meq / l is the reason for the introduction of sodium solution. If the concentration is higher - salt solutions are contraindicated. In such cases, start the introduction of glucose solution.

The introduction of insulin preparations during hyperosmolar coma is rarely practiced. The fact is that the rehydration process itself reduces the content of glucose in the blood and without additional measures. Only in exceptional cases is the administration of a limited dose of insulin - up to 2 units per hour. The introduction of a large amount of glucose-lowering drugs can lead to complication of the treatment of coma.

At the same time, the level of electrolytes is monitored. If the need arises, it is replenished by means generally accepted in medical practice. In a dangerous condition such as hyperosmolar coma, emergency care includes forced ventilation of the lungs. If necessary, other life support devices are used.

Non-invasive ventilation

Treatment of hyperosmolar coma provides mandatory gastric lavage. A urinary catheter is used to eliminate possible fluid retention in the body.

In addition, the use of therapeutic means to maintain heart health is practiced. This is necessary, taking into account the elderly age of patients who have fallen into a hyperosmolar coma, along with large volumes of solutions injected into the blood. In this case, this substance is also injected into the blood during therapy.

The administration of potassium is practiced immediately after the start of treatment, or upon receipt of the results of relevant tests 2–2.5 hours after the patient’s admission. In this case, the state of shock is the reason for the refusal of the administration of potassium preparations.

The most important task in hyperosmolar coma is to combat associated diseases that affect the patient’s condition.. Given that one of the most common causes of coma can be various infections, the use of antibiotics is warranted. Without such therapy, the chances of a positive outcome are reduced.

In a condition such as hyperosmolar coma, treatment also includes preventing the development of thrombosis. This disease is one of the most common complications of hyperosmolar coma. The lack of blood supply due to thrombosis itself can lead to serious consequences, therefore, in the treatment of coma, the administration of appropriate drugs is indicated.

The sooner the treatment is started, the more likely it is to save the patient's life!

What can you do yourself?

Of course, the best treatment should recognize the prevention of this disease.

Patients with diabetes should strictly control the level of glucose and consult a doctor when it is raised. This will prevent the development of coma.

Unfortunately, there are no home remedies that can effectively help a person with the development of hyperosmolar coma, there is no. Moreover, a waste of time for ineffective means and techniques that do not help the patient can lead to the most serious consequences.

Therefore, the only thing that a non-specialist can help with a hyperosmolar coma is to call the medical team as soon as possible or to immediately take the patient to the appropriate institution. In this case, the chances of the patient increase.

A sharp decrease in sugar content due to an unjustifiably large dose of an insulin preparation taken during the development of a coma can also cause serious pathology.

Related videos

Cognitive presentation, which describes in detail the causes and symptoms of hyperosmolar coma, as well as the principles of first aid:

In general, such a serious pathological condition, like hyperosmolar coma, implies an immediate qualified intervention. Unfortunately, even this does not always guarantee the survival of the patient. The percentage of deaths in this type of coma is quite high, primarily because of the significant risk of developing comorbidities that destroy the body and are resistant to treatment.

Watch the video: ST Fluids and Electorlytes Lecture (December 2019).