Hyperosmolar nonketotic diabetic coma

Hyperosmotic non-ketotic diabetic coma Hyperosmolar coma (HNDC) is a rare and severe acute complication of diabetes. It is more common in elderly patients with no diabetes or non-insulin-dependent diabetes, but it can also be seen in patients with insulin-dependent diabetes. The patient's original insulin secretion is insufficient, and the blood sugar rises sharply under the inducement, which promotes the disorder of glucose metabolism, resulting in hyperosmotic state of extracellular fluid, hypovolemic hyperosmolar dehydration, and insufficient cerebral cortical blood supply and deficiency. Oxygen, causing mental symptoms and coma. basic knowledge The proportion of illness: 0.005% Susceptible people: more common in the elderly Mode of infection: non-infectious Complications: heart failure, arrhythmia, renal failure

Hyperosmotic nonketotic diabetic coma

One. Stress: such as infection (especially respiratory and urinary tract infections), trauma, surgery, cerebrovascular accident, myocardial infarction, acute pancreatitis, gastrointestinal bleeding, heatstroke or hypothermia.

two. Insufficient water intake: an important factor in induction.

three. Excessive water loss: seen in severe vomiting, diarrhea, and large areas of burn patients.

four. High sugar intake.

Fives. Drugs: including a variety of glucocorticoids, diuretics, phenytoin, hibernation, propranolol, cimetidine, immunosuppressive agents, azathioprine and glycerol.

Hyperosmotic non-ketotic diabetic coma prevention

The prevention of hyperosmolar nonketotic diabetic coma is extremely important, because once the patient is ill, it will pose a great threat to his life. In general, the following measures are needed to prevent this disease:

1. To detect and correctly treat diabetes in a timely manner, it is necessary to improve the vigilance of diabetes, and often conduct self-monitoring. Once you find that you have diabetes, you should actively treat it.

2. Diabetes patients should pay attention to reasonable living arrangements, exercise properly, do not overwork, especially pay attention to drinking water, many people with diabetes are afraid of drinking water because of excessive urine, thinking that more urine is caused by drinking water, this is actually a kind of Misunderstanding, the reason why people with diabetes are mostly because their blood sugar is too high, their urine sugar concentration and urine osmotic pressure also rise, so that the reabsorption of renal tubules can not proceed normally, resulting in increased urine output, and this is related to patients. The amount of drinking water is not directly related. After the urine increases, the amount of water in the body will decrease, and the blood volume will also decrease. After the blood is concentrated, the blood sugar will also increase relatively. If the water is not replenished in time, There will be a vicious circle, which will lead to hyperosmolar non-ketotic diabetic coma. Therefore, diabetic patients should not deliberately control the amount of water (especially those with polyuria), regardless of whether they have thirst or not, the amount of water per day. It should not be less than 2500 ml.

3. Older people suffering from colds, urinary tract infections, angina pectoris, myocardial infarction and other diseases must be treated promptly, and avoid the use of certain drugs that can cause hyperosmolar non-ketotic diabetic coma, such as glucocorticoids, immunosuppressants, thiazine Diuretics and beta blockers, etc.

Hyperosmolar nonketotic diabetic coma complications Complications, heart failure, arrhythmia, renal failure

Often complicated by infection, heart failure, arrhythmia, renal failure.

Hyperosmotic non-ketotic diabetic coma symptoms Common symptoms coma polydipsia, polyuria, sleepiness, dysfunction, diabetes, polydipsia, polydipsia, dehydration, breathing, rotten apple, blood pressure drop

One. History and symptoms:

More common in the elderly, can be no history of diabetes, predisposing factors can be infection, intravenous glucose, diuretics, glucocorticoids, etc., manifested as thirst, polydipsia, urine, for several days or weeks, gradually appearing nerves, mental symptoms such as Irritable, lethargy, disorientation and even coma.

two. Physical examination found:

Changes in consciousness, such as irritability, lethargy, disorientation and even coma; marked dehydration, decreased blood pressure, and positive pathological reflex.

three. Auxiliary inspection:

Hyperglycemia>33.3mmol/L; effective plasma osmotic pressure>320moSm/L; Basically calculated effective plasma osmotic pressure=2(Na+K)+blood glucose, in mmol/L unit; urine ketone body (-) or (+) -(++).

Examination of hyperosmolar nonketotic diabetic coma

Hyperglycemia>33.3mmol/L; effective plasma osmotic pressure>320moSm/L (roughly calculated effective plasma osmotic pressure=2(Na+K)+blood glucose, in mmol/L); urinary ketone body (-) or (+)- (++).

Diagnosis and diagnosis of hyperosmolar nonketotic diabetic coma

diagnosis

Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.

Differential diagnosis

Should be differentiated from coma caused by other causes, Diabetes coma differential diagnosis table: ketoacidosis, hypoglycemia, coma, hyperosmolar coma, lactic acidosis, history of lactic acidosis, mostly in adolescents, more history of diabetes, often infection, insulin treatment interruption History of diabetes, history of diabetes, oral hypoglycemic agents, eating too little, excessive physical activity and other history occurred in the elderly, often no history of diabetes, often infected, vomiting, diarrhea and other medical history often have liver, renal insufficiency, Low blood volume shock, heart failure, drinking, taking DBI and other medical history and symptoms (2 to 4 days) have anorexia, nausea, vomiting, thirst, polyuria, lethargy and so on. There are hunger, sweating, palpitations, hand shaking and other sympathetic excitations (hours) with drowsiness, hallucinations, tremors, convulsions, etc., anorexia, nausea, lethargy and symptoms associated with the disease.

Signs of skin loss of water, dry red, damp, sweating, loss of water, loss of water, deep breathing, fast normal, deep, fast pulse, fast and full, fine speed, fine blood pressure, normal or slightly higher, lowering, urine glucose positive, ++++ negative Or + positive ++++ negative or + urinary ketone + ~ +++ negative negative or + negative or + blood glucose increased significantly, mostly 16.7 ~ 33.3mmol / L significantly decreased < 2.8mmol / L significantly increased, generally 33.3mmol / L or more normal or increased blood ketone significantly increased normal normal or slightly increased normal or slightly increased blood sodium decreased or normal normal normal or significantly increased decreased or normal PH decreased normal normal or decreased decreased CO2 binding decreased normal normal or decreased decreased lactate slightly Elevated normal normal significantly increased plasma osmotic pressure * normal or slightly elevated normal and significantly increased, often > 350 * normal * mmol / L.

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