Diabetic coma is a condition that develops as a result of a lack of insulin in the body in patients with diabetes mellitus . Insulin deficiency leads to an increase in the concentration of glucose in the blood and "hunger" of peripheral insulin-dependent tissues that are not able to utilize glucose without the participation of insulin. In response to the βhungerβ of the body, the synthesis of glucose ( gluconeogenesis ) and ketone bodies from acetyl-CoA begins in the liver - ketosis develops, and with insufficient utilization of ketone bodies and aggravation of acidosis - ketoacidosis . The accumulation of under-oxidized metabolic products, in particular lactate, leads to the development of lactic acidosis . In some cases, gross metabolic disturbances against the background of diabetes mellitus decompensation lead to the development of hyperosmolar coma .
| Diabetic coma | |
|---|---|
| ICD-10 | E10.0, E11.0, E12.0, E13.0, E14.0 |
| ICD-9 | 250.2 , 250.3 |
| Mesh | |
Diabetic coma can last a very long time - the longest case in history of a patient being in this condition is more than four decades .
Hyperglycemia
Hyperglycemic coma develops gradually, over a day or more, accompanied by dry mouth, the patient drinks a lot, if at this moment the level of glucose in the blood is increased (normal 3.3β5.5 mmol / l) by 2β3 times.
Her appearance is preceded by malaise, loss of appetite, headache, constipation or diarrhea, nausea, sometimes abdominal pain, and occasionally vomiting.
If treatment is not started in a timely manner in the initial period of development of a diabetic coma, the patient goes into a state of prostration (indifference, forgetfulness, drowsiness); his consciousness is darkened.
A distinctive feature of coma is that in addition to complete loss of consciousness, the skin is dry, warm to the touch, the smell of apples or acetone from the mouth, a weak pulse, and low blood pressure. Body temperature is normal or slightly elevated. Eyeballs are soft to the touch.
First Aid Actions
If the patient lost consciousness, it should be laid so as not to constrain his breathing, and immediately call an ambulance . In case of difficulty with the differential diagnosis of hyperglycemic coma, universal measures should be taken. First of all, the patient must be properly placed, prevent tongue retraction, enter the duct, then conduct syndromic therapy - correction of blood pressure, heart and respiratory failure according to indications. One of the universal remedies for coma should include the introduction of 10-20 ml of 40% glucose intravenously. With hyperglycemic coma, this amount of glucose will not cause a significant deterioration in metabolic processes, while with hypoglycemic coma it can literally save a patient's life. It should be borne in mind that even with low blood sugar, the patient will not sweat profusely indefinitely. If enough time has passed before the patient is detected, his skin integument will already be dry, which can be misleading.
In acute intoxications, intravenous administration of 40% glucose is also shown as in cerebral coma (compression of the brain substance with a hematoma, ischemic lesion, cerebral edema). In the latter case, intravenous administration of Lasix (furosemide) is also indicated (2β4 ml, if there is no significant decrease in blood pressure). It is still desirable to clarify the nature of the coma and also carry out special treatment. All patients in a coma of unknown etiology are taken to the intensive care unit, with acute poisoning - there, or to the toxicology department, with craniocerebral injuries to the neurosurgical department. [one]
See also
- Coma
- Glasgow Coma Scale
- Diabetes
Notes
- β Vyatkina P. Full medical reference of a medical assistant. - Moscow: Eksmo, 2010.