Diabetic (hyperglycemic) coma in children: symptoms, treatment. Sugar coma: symptoms, signs and consequences

A long-term lack of insulin in the blood of a diabetic patient can lead to the development of serious consequences, one of them is diabetic coma. Lack of insulin triggers a mechanism to increase blood glucose levels. First of all, tissues that cannot process it without this hormone begin to suffer. Further, the mechanism of "starvation" can develop in several directions. It should be borne in mind that the cause of the development of pathophysiology can be both hyperglycemia (high glucose) and hypoglycemia (low blood sugar).

Types of diabetic coma

When the hormone insulin is insufficient, glucose begins to be produced in the liver, this is a normal reaction of the body. In parallel, acetone bodies (ketone) are also produced. If glucose accumulates more than ketone bodies, then a patient with diabetes will fall into a hyperglycemic coma.

With the rapid simultaneous accumulation of acetone bodies and glucose, which are not processed, the mechanism for the development of ketoacidotic coma is triggered. If sugar and oxidized metabolic products (lactate) accumulate, then the coma will be called hypermolar or hyperlactacidemic. Hypoglycemic coma is the result of an overdose of insulin, which leads to a sharp drop in blood sugar levels.

So there are 3 types of pathophysiology in diabetic patients that lead to the development of diabetic coma.

Ketoacidotic. Most common in patients with type 1 diabetes. During the processing of fatty acids, by-products are formed - ketones, the process is especially active with a lack of insulin. The accumulation of acetone in the body for a long time causes the launch of many pathophysiological mechanisms, including coma.
Hyperglycemia or hypermolar. Reason: severe dehydration in patients with type 2 diabetes. With it, the glucose level is very high and reaches 600 mg / dl, without the presence of ketones. Usually, excess sugar is excreted by the kidneys, through the urine. If there is not enough water in the body, they try to save fluid and glucose remains inside.
Hypoglycemia. It develops in patients who take large amounts of insulin and / or eat incorrectly (skip meals). The reason for this pathophysiology may also be hidden in the overexertion of the patient or the intake of large amounts of alcohol.

Each of these lumps has its own signs and symptoms.

Signs and symptoms of developing diabetic coma

Coma in diabetes does not develop immediately, but gradually. This pathophysiology may take a day or more. The person will definitely need urgent help. If the cause is hyperglycemia, then the sugar level rises 2-3 times.

The ketoacidotic form of development is characterized by symptoms such as lethargy, nausea and vomiting, frequent urination and abdominal pain, deep and rapid breathing, and drowsiness. From the mouth it smells of acetone, often thirsty. If the hypermolar coma mechanism is triggered, the patient develops symptoms such as convulsions and impaired speech, lethargy and nausea, thirst, impaired movement and loss of sensitivity.

If the cause is a sharp drop in blood glucose levels, hypoglycemia, then there will be the following symptoms: increased heart rate, trembling and chills, increased sweating, weakness and drowsiness, confusion and changes in behavior, anxiety and fear. If no assistance is provided in the first seconds of an attack, the consequences can be serious: convulsions and loss of consciousness.

Causes prior to this condition:

Headache;
Decreased appetite;
General malaise;
Diarrhea or constipation.

If a patient with diabetes mellitus is not provided with emergency care in time, then everything can end very sadly. With such pathophysiology, it is worth paying attention to body temperature. It may be within the normal range or slightly overestimated. The skin will be warm and dry.

The following symptoms should already be alarming. If help is not provided on time, the mechanism of development of this state passes to the next stage. There is a state of prostration. The patient begins to forget simple details, to become indifferent to the actions taking place around. He constantly wants to sleep and he does not always understand where he is and what is happening.

The hallmarks of a coma, in addition to those mentioned above, are a decrease in blood pressure, a weak pulse, and the eyeballs become soft to the touch. To stop the mechanism of development, urgent help and knowledge of what can be done in this situation is needed.

Treatment

The first steps to stop the mechanism of development of diabetic coma:

Call for emergency help.
The patient should be turned to one side so that he does not suffocate.
If you have a glucometer, you should measure your blood sugar levels.
You should not immediately inject insulin, especially if the level of glucose in the blood is unknown, the cause of coma, on the contrary, is associated with its overdose. Then the injection can be fatal.
An unconscious patient should not try to give something to swallow or drink.
If it is reliably known that the cause of the pathophysiology is low sugar levels, then you should give the person some sugar, juice or a glucose tablet, but not foods for diabetics.
If the patient is conscious and thirsty, they give him a drink and try to take him to the hospital as soon as possible.

The prognosis for the development of this condition can be both positive and negative. Approximately 10% of all dietary complications end in death. The main thing is to quickly provide emergency care and take the person to the hospital in order to restore glucose levels.

Emergency care is provided in the intensive care unit. Treatment is carried out with the help of droppers and injections, through which various solutions are introduced into the body that restore the electrolyte composition, normalize blood acidity and remove the effects of dehydration. The whole process can take several days. After the prognosis becomes positive, the patient is sent to the endocrinology department. There he remains until the state is completely stabilized.

Diabetic coma is a serious pathophysiology in which the patient needs emergency care and timely treatment.

A person cannot independently stop this mechanism that destroys him. Only if all the rules are followed and the response is quick, the forecast will be positive, and the consequences will be minimal.

It is important to know:

Diabetes belongs to a group of diseases in which the level of sugar in the blood rises. This condition can lead to premature aging of the body and damage to almost all of its organs and systems.

Endocrinologists are convinced that with the observance of preventive measures and competent therapy, in most cases it is possible to prevent or even stop the onset of coma in diabetes. Indeed, in most cases, such a complication occurs with untimely therapy, insufficient self-control and non-compliance with the diet.

As a result, a hypoglycemic state develops, which leads to the development of coma in diabetes mellitus. Sometimes the lack of timely relief of such a phenomenon can even cause death.

What is diabetic coma and what are its causes and types?

The definition of diabetic coma - characterizes a condition in which a diabetic loses consciousness when there is a deficiency or excess of glucose in the blood. If in such a state the patient is not provided with emergency care, then everything can end in death.

The leading causes of diabetic coma are a rapid increase in the concentration of glucose in the blood, which is caused by insufficient secretion of insulin by the pancreas, lack of self-control, illiterate therapy, and so on.

Without enough insulin, the body cannot process glucose, which prevents it from being converted into energy. This deficiency leads to the fact that the liver begins to produce glucose on its own. Against this background, there is an active production of ketone bodies.

So, if glucose accumulates in the blood faster than ketone bodies, then the person loses consciousness and develops a diabetic coma. If the concentration of sugar increases along with the content of ketone bodies, then the patient may fall into a ketoacidotic coma. But there are other types of such conditions, which should be considered in more detail.

In general, there are such types of diabetic coma:

hypoglycemic;
hyperglycemic;
ketoacidotic.

Hypoglycemic coma - can occur when the level of sugar in the blood stream drops suddenly. It is impossible to say how long this condition will last, because a lot depends on the severity of hypoglycemia and the health of the patient. This condition affects diabetics who skip meals or those who do not comply with the dosage of insulin. Hypoglycemia also appears after overexertion or alcohol abuse.

The second type, hyperosmolar coma, occurs as a complication of type 2 diabetes, which causes a lack of water and excessive blood sugar. Its onset occurs at a glucose level of more than 600 mg / l.

Often, excessive hyperglycemia is compensated by the kidneys, which excrete excess glucose along with urine. In this case, the reason for the development of coma is that during the dehydration created by the kidneys, the body is forced to conserve water, which can cause severe hyperglycemia.

Hyperosmolar s. diabeticum (Latin) develops 10 times more often than hyperglycemia. Basically, its appearance is diagnosed in type 2 diabetes in elderly patients.

Ketoacidotic diabetic coma develops in type 1 diabetes. This type of coma can occur when ketones (harmful acetone acids) accumulate in the body. They are by-products of fatty acid metabolism resulting from an acute deficiency of the hormone insulin.

Hyperlactacidemic coma in diabetes mellitus is extremely rare. This variety is typical for elderly patients with disorders in the liver, kidneys and heart.

The reasons for the development of this type of diabetic coma are increased formation and poor utilization of hypoxia and lactate. Thus, the body is poisoned by lactic acid accumulated in excess (2-4 mmol / l). All this leads to an imbalance of lactate-pyruvate and the appearance of metabolic acidosis with a significant anion gap.

A coma that occurs on the background of type 2 or type 1 diabetes is the most common and dangerous complication for an adult who is already 30 years old. But this phenomenon is especially dangerous for minor patients.

Diabetic coma in children often develops with an insulin-dependent form of the disease that has been occurring for many years. Diabetic coma in children often appear at preschool or school age, sometimes in infancy.

Moreover, at the age of 3 years, such conditions occur much more often than in adults.

Symptoms

The types of coma and diabetes are different, so their clinical picture may be different. So, for ketoacidotic coma, dehydration is characteristic, accompanied by a weight loss of up to 10% and dry skin.

At the same time, the face becomes painfully pale (occasionally reddens), and the skin on the soles, palms turns yellow, itches and flakes. Some diabetics have furunculosis.

Other symptoms of diabetic coma in ketoacidosis are putrid breath, nausea, vomiting, muscle flaccidity, cold extremities, and low temperature. Due to intoxication of the body, hyperventilation of the lungs can occur, and breathing becomes noisy, deep and frequent.

When a diabetic coma occurs in type 2 diabetes, its symptoms also include reduced tone of the eyeballs and constriction of the pupils. Occasionally, drooping of the upper eyelid and strabismus are noted.

Also, developing ketoacidosis is accompanied by frequent spontaneous urination, in which the discharge has a fruity odor. At the same time, the stomach hurts, intestinal peristalsis is weakened, and the level of blood pressure is reduced.

Ketoacidotic coma in diabetics can have different degrees of severity - from drowsiness to lethargy. Intoxication of the brain contributes to the appearance of epileptic seizures, hallucinations, delirium and confusion

Hyperosmolar diabetic coma signs:

convulsions;
dehydration;
speech disorder;
malaise;
neurological symptoms;
involuntary and rapid movements of the eyeball;
infrequent and weak urination.

Signs of diabetic coma with hypoglycemia are slightly different from other types of coma. This condition may be characterized by severe weakness, hunger, causeless anxiety and fear, chills, trembling and sweating of the body. The consequences of diabetic coma with hypoglycemia are loss of consciousness and the appearance of convulsions.

Hyperlactacidemic diabetic coma is characterized by dryness of the tongue and skin, Kussmaul-type breathing, collapse, hypotension, and decreased turgor. Also, a coma period, lasting from a couple of hours to several days, is accompanied by tachycardia, oliguria, turning into anuria, softness of the eyeballs.

Hypoglycemic coma and other types of similar conditions in children develop gradually. Diabetic precoma is accompanied by abdominal discomfort, restlessness, thirst, drowsiness, headache, poor appetite, and nausea. As it develops, the patient's breathing becomes noisy, deep, the pulse speeds up, and arterial hypotension appears.

In diabetes mellitus in infants, when the child begins to fall into a coma, he has polyuria, constipation, polyphagia and increased thirst. His diapers are hard with urine.

Children show the same symptoms as adults.

What to do with a diabetic coma?

If first aid for complications of hyperglycemia is untimely, then the patient has a diabetic coma, the consequences of which are extremely dangerous, it can result in pulmonary and cerebral edema, thrombosis, leading to heart attacks and strokes, oliguria, renal or respiratory failure, and others. Therefore, after the diagnosis has been made, the patient should be immediately treated for diabetic coma.

So, if the patient's condition is close to fainting, then it is necessary to make an urgent call for an ambulance. While she is going, you need to lay the patient on his stomach or on his side, introduce an air duct and prevent the tongue from sinking. If necessary, it is necessary to normalize the pressure.

And what to do with a diabetic coma caused by an excess of ketones? In this situation, the algorithm of actions is to normalize the vital functions of a diabetic, such as pressure, heartbeat, consciousness and breathing.

If a lactatacidemic coma has developed in diabetes mellitus, then it is necessary to take the same measures as with ketoacidotic. But in addition to this, it is necessary to restore the water-electrolyte and acid-base balance. Also, help with a diabetic coma of this type consists in administering a glucose solution with insulin to the patient and performing symptomatic therapy.

If a mild hypoglycemic coma occurs with type 2 diabetes, then self-help is possible. This period will not last long, so the patient should have time to take fast carbohydrates (a few pieces of sugar, a spoonful of jam, a glass of fruit juice) and take a comfortable position so as not to injure himself if he loses consciousness.

If provoked by insulin, the action of which lasts a long time, then the diet for diabetic coma involves taking slow carbohydrates in the amount of 1-2 XE before bedtime.

Diabetic coma is a condition in which a person with diabetes mellitus loses consciousness due to too low (hypoglycemia) or too high (hyperglycemia) blood glucose levels. If medical assistance is not provided in time, this condition can lead to death.

Types and causes of coma in diabetes mellitus

Distinguish three types of diabetic coma: hypoglycemic, hyperosmolar and ketoacidotic.

Hypoglycemic coma- a condition in which the blood sugar level drops sharply. Hypoglycemia is often seen in diabetic patients who skip meals or take too much insulin. Also, the cause of hypoglycemic coma can be alcohol intake or overexertion.

Hyperosmolar coma is a complication of type 2 diabetes caused by severe dehydration and too high blood glucose (more than 600 mg/dl). As a rule, high blood sugar is compensated by the kidneys, removing excess glucose in the urine. Pathophysiology The mechanism of development of diabetic coma is explained by the fact that when the body is dehydrated, the kidneys have to “save” fluid, as a result of which the glucose level rises. This condition leads to a greater need for fluid.

Ketoacidotic coma most common in patients. The cause of this type of diabetic coma is the accumulation of harmful acids - ketones, in particular acetone. Ketones are by-products of fatty acid metabolism that are actively formed during acute insulin deficiency.

Symptoms and diagnosis of diabetic coma

The main signs of a diabetic coma include:

decrease in appetite;
increased feeling of thirst;
frequent urge to urinate;
nausea, sometimes accompanied by vomiting;
headache;
general weakness;
nervous excitement, which is abruptly replaced by drowsiness.

If this condition lasts for 12-24 hours without the necessary treatment, the patient develops a true coma, the signs of which are as follows:

indifference to everything around;
disturbance of consciousness with periods of enlightenment;
lack of consciousness, as well as reaction to any stimulus.

When examined at an early stage of the development of this condition, the doctor detects the following symptoms of diabetic coma:

weakening of the pulse;
lowering blood pressure;
dry skin;
the smell of sour apples or acetone from the mouth (with ketoacidotic and hyperglycemic coma).

The symptoms of hypoglycemic coma are different from signs of ketoacidotic and hyperglycemic coma. These include:

strong feeling of hunger;
increased sweating throughout the body;
severe general weakness that develops in a matter of minutes;
trembling all over;
anxiety and fear.

If this condition is not stopped within a few minutes, the patient may experience convulsions, he loses consciousness. In this case, the skin of a person is usually moist, and the muscles are tense.

Diagnostics

For the diagnosis of coma of any kind in diabetes mellitus, except for a doctor's examination laboratory testing is also required., including a general blood test, a biochemical blood test, a blood sugar test, a biochemical analysis of urine.

With hypoglycemic coma, the blood contains glucose less than 1.5 mmol / liter. In hyperglycemic types of coma, the content of glucose in the blood exceeds 33 mmol / liter. With hyperosmolar coma, the osmolarity of blood plasma increases. With ketoacidosis, ketone bodies appear in the urine.

First aid for diabetic coma

It would seem logical to immediately introduce insulin to the patient. However, doing so is strictly contraindicated. After the injection of insulin, all glucose and fluid from the bloodstream will begin to flow into the cells. In this case, the brain will suffer first. In such cases, patients die within minutes from cerebral edema. That's why emergency care for diabetic coma excludes the introduction of insulin to the patient.

If a diabetic person goes into a coma, your main task is to keep him alive until the ambulance arrives. Therefore, before calling it, turn the patient on his stomach or on his side. By doing this, you will ensure his airway. Even if a person has even and calm breathing, leave it you can't lie on your back because he can vomit at any moment. All danger of diabetic coma from the first minutes thing is the patient may suffocate from retraction of the tongue or to choke on one's own vomit.

While waiting for the doctor observe breathing patterns sick. In addition, help in diabetic coma is to maintain airway patency. Therefore it should clean the patient's mouth with a tissue from content.

Treatment

To treat a diabetic coma, it is necessary first of all to restore blood sugar levels. This can be achieved by administering insulin and, in the case of hypoglycemia, by administering glucose. In addition, the patient needs infusion therapy with special solutions that restore electrolyte disturbances, eliminate dehydration and normalize blood acidity. Treatment is carried out for several days in the intensive care unit.. After that, to stabilize the patient's condition, he is transferred to the endocrinology department.

Forecast

In the case of a timely appeal to the ambulance team or to the attending physician, a violation of the patient's consciousness can be avoided and even restore his condition. Otherwise, without proper care, the consequences of a diabetic coma can be fatal. About 10% of patients with this complication die due to lack of timely assistance.

Under diabetic coma, it is necessary to understand the complication and consequences of the course of diabetes mellitus. This condition develops quite acutely and can be easily reversible. It is generally accepted that an excessive level of sugar in the blood of a sick person (hyperglycemic condition) can lead to a diabetic coma. In addition, with the disease, a coma can be observed:

hyperosmolar;
hypoglycemic (occurs in type 2 diabetes);
hyperlactacidemic;
ketoacidotic (more common in type 1 diabetes).

The main causes of the development of a pathological condition

The main factors that lead to the onset of the development of a diabetic coma include too rapid an increase in the sugar content in the blood of a sick person. This can be caused, for example, as a consequence of non-compliance with a medical diet. Patients are aware, it is difficult not to notice it, but its manifestations are often ignored, which is fraught with coma.

The lack of internal insulin and the wrong treatment regimen for the disease can also provoke hyperglycemic coma. The consequences of this are that insulin is not supplied, which prevents glucose from being processed into substances important for the human body.

In such a situation, the liver begins the unauthorized production of glucose, believing that the necessary elements did not enter the body precisely because of its insufficient level. In addition to this, active production of ketone bodies begins, which, subject to excessive accumulation of glucose in the body, leads to loss of consciousness and coma.

In such situations, the presence of ketone bodies along with glucose occurs on such a large scale that the body of a sick person is simply not able to adequately respond to such a process. The result is a ketoacidotic coma.

There are cases when, along with sugar, the body accumulated lactates and other substances, which provoked the onset of hyperlactacidemic (hyperosmolar) coma.

It is important to note that not all cases in which diabetic coma is observed in diabetes mellitus are caused by excessive levels of glucose in the blood, because sometimes there can be an overdose of insulin. Under such conditions, there is a sharp decrease in blood sugar to a level below the possible norm, and the patient falls into a state of hypoglycemic coma.

Symptoms of the onset of the development of a coma

The symptoms of coma in diabetes mellitus are similar to each other, which makes it necessary to draw accurate conclusions only after appropriate laboratory tests. To start the development of a sugar coma, a blood glucose level above 33 mmol / liter is necessary (3.3-5.5 mmol / liter is considered the norm).

Coma symptoms:

frequent urination;
pain in the head;
loss of appetite;
increased thirst;
general pronounced weakness;
nervous excitement that turns into drowsiness, symptoms that are hard to miss;
nausea;
vomiting (not always).

If such symptoms last from 12 to 24 hours without adequate and timely medical attention, then the patient may fall into a state of true coma. She is characterized by:

complete indifference to the surrounding people and what is happening;
disturbed consciousness;
dry skin;
complete lack of consciousness and reactions to any stimuli;
soft eyes;
decrease in heart rate;
the smell of acetone from the patient's mouth;
drop in blood pressure.

If we are talking about a hypoglycemic coma, then it will be slightly different, demonstrating other symptoms. In such situations, there will be a sharp feeling of hunger, fear, anxiety, trembling in the body, a lightning-fast feeling of weakness, sweating.

You can stop the onset of the development of this condition by consuming a small amount of sweets, such as sugar. If this is not done, then there may be a loss of consciousness and the onset of convulsions. At the same time, the muscles will be in good shape, and the skin will become moist.

How is diabetic coma diagnosed?

To detect coma in diabetes mellitus, it is necessary not only to see a doctor, but also to conduct important laboratory tests. These include a complete blood count, biochemistry of urine, blood, as well as an analysis of the level of sugar.

Any type of coma in case of illness will be characterized by the presence of sugar in the blood of more than 33 mmol / liter, and glucose will also be detected in the urine. With hyperglycemic coma, there will be no other symptoms characteristic of it.

Ketoacidotic coma is characterized by the presence of ketone bodies in the urine. For hyperosmolar - an excessive level of plasma osmolarity. Hyperlactacidemic is characterized by an increase in the level of lactic acid in the blood.

How is the treatment?

Any diabetic coma involves its own treatment, first of all, it is necessary to restore the optimal level of sugar in the blood, accurate symptoms are important here.

This can easily be achieved by administering insulin (or glucose in case of hypoglycemia). In addition, a course of infusion therapy is performed, which includes droppers and injections with special solutions that can eliminate blood electrolyte disturbances, relieve dehydration and normalize acidity.

All these procedures are carried out in intensive care for several days. After that, the patient can be transferred to the endocrinology department, where his condition will be stabilized, and then he must clearly adhere to the state in which he will be in a normal state.

Diabetic coma - consequences

As in any other cases, if you seek qualified medical help in a timely manner, it will be possible to avoid not only impairment and loss of consciousness, but also to qualitatively restore the condition of a sick person at the initial stages of the development of a diabetic coma. If this is not done, then soon enough the patient may die. According to current medical statistics, mortality in the development of such complications of diabetes mellitus is about 10 percent of the total number of patients with this disease.

Patients with diabetes are wondering: diabetic coma: what is it? What awaits a diabetic if insulin is not taken on time, preventive therapy is not carried out? And the most important question that worries patients of endocrine departments in polyclinics: If blood sugar is 30, what should I do? And what is the limit to coma?
It would be more correct to talk about diabetic coma, since 4 types of coma are known. The first three are hyperglycemic, associated with an increased concentration of sugar in the blood.

Ketoacidotic coma

Ketoacidotic coma is common in patients with type 1 diabetes. This critical condition occurs due to insulin deficiency, as a result of which glucose utilization is reduced, metabolism is deranged at all levels, and this leads to the failure of the functions of all systems and individual organs. The main etiological factor in ketoacidotic coma is insufficient insulin administration and a sharp jump in blood glucose levels. Hyperglycemia reaches - 19-33 mmol / l and above. The result is a deep faint.

Usually, ketoacidotic coma develops within 1-2 days, but in the presence of provoking factors, it can develop faster. The first manifestations of diabetic precoma are signs of an increase in blood sugar: increasing lethargy, desire to drink, polyuria, acetone breath odor. The skin and mucous membranes are dry, there are pains in the abdomen, headaches. As the coma increases, polyuria can be replaced by anuria, blood pressure drops, the pulse quickens, muscle hypotension is observed. When the concentration of sugar in the blood is above 15 mmol / l, the patient must be placed in a hospital.

Ketoacidotic coma is the last degree of diabetes, expressed by a complete loss of consciousness, and if the patient is not helped, death may occur. You need to call emergency help immediately.

For untimely or insufficient administration of insulin are the following reasons:

The patient does not know about his disease, did not go to the hospital, so diabetes was not detected in a timely manner.
Insulin administered is of poor quality or expired;
A gross violation of the diet, the use of easily digestible carbohydrates, an abundance of fats, alcohol, or prolonged fasting.
Suicidal tendencies.

Patients should be aware that in type 1 diabetes, the need for insulin increases in the following cases:

during pregnancy,
with concomitant infections,
in cases of trauma and surgery,
with long-term administration of glucocorticoids or diuretics,
during physical exertion, psycho-emotional stress states.

The pathogenesis of ketoacidosis

The lack of insulin is the result of an increase in the production of corticoid hormones - glucagon, cortisol, catecholamines, adrenocorticotropic and somatotropic hormones. The entry of glucose into the liver, muscle cells and adipose tissue is blocked, its level in the blood rises, and a state of hyperglycemia occurs. But at the same time, cells experience energy hunger. Therefore, patients with diabetes experience a state of weakness, impotence.

In order to somehow make up for energy hunger, the body launches other energy replenishment mechanisms - it activates lipolysis (decomposition of fats), which results in the formation of free fatty acids, non-esterified fatty acids triacylglycerides. With a lack of insulin, the body receives 80% of the energy from the oxidation of free fatty acids, the by-products of their decay (acetone, acetoacetic and β-hydroxybutyric acids), which make up the so-called ketone bodies, accumulate. This explains the dramatic weight loss in diabetics. An excess of ketone bodies in the body absorbs alkaline reserves, resulting in the development of ketoacidosis, a severe metabolic pathology. Simultaneously with ketoacidosis, water-electrolyte metabolism is disturbed.

Hyperosmolar (non-ketoacidotic) coma

Hyperosmolar coma is prone to patients suffering from type 2 diabetes. This type of coma in diabetes mellitus occurs due to a lack of insulin, and is characterized by a sharp dehydration of the body, hyperosmolarity (increased concentration of sodium, glucose and urea ions in the blood).

Hyperosmolarity of the blood plasma leads to serious dysfunctions of the body, loss of consciousness, but in the absence of ketoacidosis, which is explained by the production of insulin by the pancreas, which is still insufficient to eliminate hyperglycemia.

To dehydration of the body, which is one of the causes of diabetic hyperosmolar coma, lead

excessive use of diuretics,
diarrhea and vomiting of any etiology,
living in areas with a hot climate, or working in conditions of elevated temperatures;
lack of drinking water.

The following factors also influence the occurrence of coma:

insulin deficiency;
Associated diabetes insipidus;
Abuse of products containing carbohydrates, or injections of glucose in large doses;
or peritoneal dialysis, or hemodialysis (procedures associated with cleansing the kidneys or peritoneum).
Prolonged bleeding.

The development of hyperosmolar coma has common features with ketoacidotic coma. How long the precoma lasts depends on the state of the pancreas, its ability to produce insulin.

Hyperlactacidemic coma and its consequences

Hyperlactacidemic coma occurs due to the accumulation of lactic acid in the blood due to a lack of insulin. This leads to a change in the chemical composition of the blood and loss of consciousness. The following factors can provoke hyperlactacidemic coma:

Insufficient amount of oxygen in the blood due to heart and respiratory failure that occurs in the presence of pathologies such as bronchial asthma, bronchitis, circulatory failure, cardiac pathologies;
Inflammatory diseases, infections;
Chronic kidney or liver disease;
Protracted alcoholism;

Pathogenesis

The main cause of hyperlactacidemic coma is a lack of oxygen in the blood (hypoxia) against the background of insulin deficiency. Hypoxia stimulates anaerobic glycolysis, which produces excess lactic acid. Due to the lack of insulin, the activity of the enzyme that promotes the conversion of pyruvic acid to acetylcoenzyme is reduced. As a result, pyruvic acid is converted to lactic acid and accumulates in the blood.

Due to oxygen deficiency, the liver is unable to utilize excess lactate. Altered blood causes a violation of contractility and excitability of the heart muscle, narrowing of peripheral vessels, resulting in coma

Consequences, and at the same time symptoms of hyperlactacidemic coma are muscle pain, angina pectoris, nausea, vomiting, drowsiness, clouding of consciousness.

Knowing this, you can prevent the onset of coma, which develops over several days, if you put the patient in a hospital.

All of the above types of lumps are hyperglycemic, that is, they develop as a result of a sharp increase in blood sugar levels. But the reverse process is also possible, when the sugar level drops sharply, and then a hypoglycemic coma can occur.

Hypoglycemic coma

Hypoglycemic coma in diabetes mellitus has the reverse mechanism, and can develop when the amount of glucose in the blood is lowered so much that there is an energy shortage in the brain.

This condition occurs in the following cases:

When an overdose of insulin or hypoglycemic oral drugs is allowed;
The patient did not eat on time after taking insulin, or the diet was insufficient in carbohydrates;
Sometimes the function of the adrenal glands, the insulin-activating ability of the liver, decreases, as a result, insulin sensitivity increases.
After intense physical work;

A meager supply of glucose to the brain provokes hypoxia and, as a result, a violation of the metabolism of proteins and carbohydrates in the cells of the central nervous system.

Signs of hypoglycemia:

Increased feeling of hunger;
decreased physical and mental performance;
change in mood and inappropriate behavior, which can be expressed in excessive aggression, anxiety;
hand trembling;
tachycardia;
pallor;
Increased blood pressure;

With a decrease in blood sugar to 3.33-2.77 mmol / l (50-60 mg%), the first mild hypoglycemic phenomena occur. In this state, the patient can be helped by giving him warm tea or sweet water with 4 pieces of sugar to drink. Instead of sugar, you can put a spoonful of honey, jam.

At a blood sugar level of 2.77-1.66 mmol / l, all the signs characteristic of hypoglycemia are observed. If there is a person next to the patient who is able to inject, glucose can be injected into the blood. But the patient will still have to go to the hospital for treatment.

With a sugar deficiency of 1.66-1.38 mmol / l (25-30 mg%) and below, consciousness is usually lost. An ambulance needs to be called urgently.