Diabetic hyperglycemic hyperosmolar coma.
Diabetic hyperglycemic hyperosmolar or non-ketotic coma is a  dangerous condition characterized by sharp increase of blood glucose level, severe dehydration and the absence of ketoacidosis signs. It occurs mainly in elderly people suffering from type 2 diabetes and it is associated with poor health state. The latest can be an aftermath of a recent surgery, heart attack, stroke, renal failure, infectious disease, poor diabetes management and serious chronic diseases. The use of certain medications, such as diuretics, which increase urination, can lead to general dehydration and diabetic hyperglycemic hyperosmolar coma, if the water intake is not adequate.
In normal conditions, the kidneys contribute to glucose control by excreting the excessive amounts of it in urine. However, when dehydration occurs, the kidneys try to save water by reducing the production of urine. Therefore, the excessive glucose cannot be excreted and builds up in the blood stream. In a case of diabetic hyperglycemic hyperosmolar coma, the blood glucose level can reach or exceed the 600mg/dL. High concentrations of glucose and sodium in the body fluids increase their osmolarity. This, in turn, leads to water transfer through the membrane from the interior of the cell into the surrounding environment, resulting in cellular dehydration and impaired function.
Signs and symptoms of diabetic hyperglycemic hyperosmolar coma.
Early signs can be prolonged periods of increased thirst and/or excessive urination. When the condition occurs, drowsiness, decreased consciousness, restlessness, lethargy, confusion, fatigue, partial paralysis, headaches, difficulty in speech, palpitations, low blood pressure, nausea, impaired muscular function and spasms can follow.
Treatment of diabetic hyperglycemic hyperosmolar coma.
The condition has to be treated urgently, because it may be fatal. In most of the cases, hospitalization is needed, since intravenous therapy is necessary to deal with dehydration and hyperglycemia. Normal glucose level and electrolyte balance must be restored immediately.
Complications of diabetic hyperglycemic hyperosmolar coma.
As it has been already mentioned, if the condition is not treated in time, it can be extremely dangerous. Fatality rates reach 40% of the cases. Blood clot formation, brain swelling, acute circulatory collapse and increased blood acidity are the most typical and serious complications. |
