Diabetes

Diabetic Hyperosmolar Coma

Diabetic hyperosmolar coma is, in some patients with diabetes or high blood sugar caused by dehydration of the incentives under the extremely elevated blood glucose, high serum sodium, plasma osmotic pressure increased, appearance of the neurological symptoms as the main performance of clinical syndrome, but also called non-ketotic hyperosmolar diabetic coma.

Hyperosmolar coma Diabetic ketoacidosis is different from another acute diabetes complications, mainly seen in the age of 50 with type 2 diabetes, with up to 50% of patients without a clear history of diabetes, only this as the first performance, in a certain incentives, such as infection, under the facilitation of glucose metabolism in the short term a serious disorder, blood sugar is too high, there consciousness disorder and severe dehydration, serious consequences and poor prognosis. Tianjin Metabolic Diseases Hospital, said Professor Yu Demin, hyperosmolar coma while dangerous, but the usual attention to self-care, is entirely preventable and treatable.

Incentives

In the absence of insulin, based on some common factors that can induce diabetic hyperosmolar coma, these factors include:

Stress: The most common infection, especially lung infections, urinary tract infection, gastroenteritis, septicemia, etc., in a number of factors could account for 2 / 3. In addition, including trauma, surgery, myocardial infarction, gastrointestinal bleeding, stroke and so on.

Water shortage: more common in the elderly decreased sensitivity to thirst center, life can not take care of themselves, or coma patients.

Excessive water loss: such as fever, severe vomiting, diarrhea, high intake of sugars; to drink a lot of high sugar drinks or intravenous high-sugar, etc..

Drugs: a large number of taking drugs affecting glucose metabolism, such as: adrenal cortex hormones, diuretics, propranolol, cimetidine, wintermine so.

In recent years, the increasing popularity of the application of insulin pumps, there are individual patients are not promptly check the hidden problems, such as catheter blockage can lead to the disease.

Sometimes in the same time, the presence of several factors induced diabetic hyperosmolar coma.

Place

This disease is the lack of context in insulin, coupled with the presence of these incentives result. Patients with a lack of insulin itself, the existence of incentives to make it heavier, resulting in elevated blood sugar, high blood sugar lead to osmotic diuresis, loss of body water and electrolytes such as potassium, sodium, and water loss greater than the loss of sodium potassium loss; At the same time, body compensatory function of the corresponding decrease (decreased sensitivity to thirst center, to reduce the release of antidiuretic hormone, ADH), blood concentration, resulting in reduction of renal blood flow, glucose and sodium to reduce exclusion, promote blood sugar, serum sodium increased further, causing a vicious circle, resulting in a severe dehydration, and there are different levels of consciousness.

Features

Patients with more than 60 years of age or older, 2 / 3, history of diabetes.

Onset more slowly, the first 3 to 5 days have prodromal symptoms such as thirst, polydipsia, polyuria increased, or there gastrointestinal symptoms such as nausea and vomiting.

Water loss in patients with obvious signs: weight loss, enophthalmos, skin dry fast and thin veins and so on.

Symptoms of central nervous system damage: such as hemiplegia, hemianopia, limitations convulsions, epilepsy, aphasia and so on.

Symptoms of incentives: if the lung infection, urinary tract infections.

Complications

If not timely diagnosis and treatment of this disease, condition aggravated, serious consequences, there may be a series of complications: such as blood clots, circulation disorder, heart failure, renal failure, respiratory failure, respiratory distress syndrome, stress ulcer gastrointestinal bleeding caused by , Disseminated intravascular coagulation (DIC), cerebral edema, cerebrovascular accident, serious arrhythmia, conduction block and so on, these are the performance of multiple organ failure, multi-occurred in coma patients.

Prevention

Elderly patients with diabetes self-care to enhance the awareness of effective treatment of diabetes and impaired glucose tolerance (IGT), strict control of blood glucose. If there is thirst, polydipsia, polyuria increased, or there gastrointestinal symptoms such as nausea, vomiting and other symptoms that required immediate treatment, regular treatment.

Should pay attention to drinking water to prevent dehydration. Note that restrictions on the consumption of sugary drinks.

Prevent all infections, stress and so on.

Or used with caution in elderly patients with diabetes do not have dehydration and elevated blood sugar drugs, such as furosemide (furosemide), Hydrochlorothiazide (Hydrochlorothiazide), phenytoin, glucocorticoids (prednisone, etc.), propranolol (propranolol). In the application of dehydration treatment, including kidney dialysis treatment should be close monitoring of blood glucose, blood osmotic pressure and urine output.

Prognosis

Poor prognosis of this disease, the mortality rate as high as 40% to 70%, the following factors influencing the prognosis:

The higher the age the greater the mortality. Statistics found that of those who died more than 60 years of age.

Prior to the onset of diabetes chronic complications, high mortality, including diabetes, kidney disease, coronary heart disease, cerebral infarction, hypertension, chronic bronchitis and emphysema.

The longer the coma, the higher mortality rate.

From severe infection, myocardial infarction, cerebrovascular accidents, etc. hyperosmolar coma induced by a higher death rate.

Were it not for timely medical treatment, the incidence more than 4 ~ 6 hours for treatment by a high mortality rate.

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