Hyperosmolar coma

Introduction Hyperosmolar non-ketotic diabetic coma, referred to as hyperosmolar coma, is a rare and serious acute diabetic complication. Its main clinical features are severe hyperglycemia, dehydration, and elevated plasma osmotic pressure without obvious Ketoacidosis.

Cause

First, stress: such as infection (especially respiratory and urinary tract infections), trauma, surgery, cerebrovascular accident, myocardial infarction, acute pancreatitis, gastrointestinal bleeding, heat stroke or low temperature.

Second, insufficient water intake: is an important factor induced.

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

Fourth, high sugar intake.

5. Drugs: including various glucocorticoids, diuretics, phenytoin, hibernation, propranolol, cimetidine, immunosuppressants, azathioprine and glycerol.

an examination

Related inspection

Oxygen saturation arterial oxygen partial pressure (PaO2) blood glucose total blood glucose Hb plasma osmotic pressure (POP)

First, medical history and symptoms:

More common in the elderly, without diabetes history, the predisposing factors can be infection, intravenous glucose, diuretics, glucocorticoids. It is characterized by thirst, polydipsia and polyuria for several days or weeks, and gradually develops neurological and psychiatric symptoms such as irritability, lethargy, disorientation and even coma.

Second, physical examination found:

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

Third, auxiliary inspection:

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

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

Differential diagnosis

Identification:

It should be differentiated from coma caused by other causes. Diagnostic diagnosis of diabetic coma: ketoacidosis, hypoglycemia coma, hyperosmolar coma, lactic acidosis.

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