Diabetic coma - Causes, symptoms and treatment. MF.
Diabetes mellitus is a widespread chronic disease characterized by a metabolic disorder. Diabetes is dangerous not only for late complications( damage to the nervous tissue, blood vessels, liver, kidneys), but also acute conditions( coma).Urgent conditions in diabetes mellitus are diverse in terms of the cause and mechanism of their occurrence. The coma may be associated with low blood glucose levels or, conversely, occur against a background of hyperglycemia( increased sugar).Currently, there are three variants of diabetic coma with elevated blood sugar levels( diabetic ketoacidosis, hyperosmolar coma, lactate acidosis) and hypoglycemic coma with low sugar.
Diabetic ketoacidosis
Diabetic ketoacidosis is actually an extremely difficult stage of metabolic disorders in type 1 diabetes mellitus .In rare cases, this coma may be in a patient with type 2 disease.
The reason for this urgent condition is the almost complete absence of insulin in the body. This situation occurs with late diagnosed type 1 diabetes. In this case, its secretion of insulin in the body is impossible due to the death of beta cells in the pancreas, and treatment is not performed, since the diagnosis is not yet established. Late diagnosis of diabetes usually in young adult patients prone to carry any diseases on their feet and not pay attention to the ailments. In addition, after 18 years, the destruction of beta-cells is slower than in childhood, which means that the diabetes progresses somewhat more slowly, which allows a person to adapt to life with the disease for a long time. Ultimately, such a patient patient immediately enters the hospital in the ambulance, bypassing the stage of examination in the clinic.
Also violations of the treatment regimen of type 1 diabetes lead to the development of ketoacidosis. Typical mistakes include the use of overdue insulin or its improper storage, malfunctions in insulin delivery systems( syringe pens, pumps), incorrect calculation of the insulin dose by the number of carbohydrates. In some cases, the ketoacidic coma occurs when the insulin is uncharged. The idea to refuse treatment can come to the patient under the influence of a public negative opinion about insulin injections or after studying pseudoscientific techniques in the Internet that promise cure for type 1 diabetes. The failure of insulin in this disease in a few days leads to the development of a diabetic ketoacidotic coma.
Severe concomitant diseases( infections, inflammations, heart attacks, strokes) also lead to the development of such a coma.
Symptoms of ketoacidosis
The mechanism of the development of ketoacidosis consists of several links. In the absence of insulin, the blood sugar level rises sharply. Excess glucose begins to be excreted through the kidneys, taking with them and a large amount of fluid. This leads to severe dehydration. The patient often goes to the toilet and drinks a lot of water every hour. Skin and mucous membranes become dry, lose elasticity. In a tissue sugar can not penetrate, therefore, within the cells as energy material, fat reserves are consumed. The patient begins to lose weight quickly .During the breakdown of adipose tissue, a large number of ketone bodies and free fatty acids are released. These substances in large quantities accumulate in the blood. The acid-base balance of blood changes. Acid in the blood irritates the respiratory center. The person has shortness of breath or deep noisy breathing. In the exhaled air there is an admixture of ketone bodies. In the room where the patient is feeling smell of acetone .
Ketoacidosis develops within a few days, less often hours. Gradually the patient's condition changes. As this acute complication progresses, the patient becomes less and less sociable, monosyllables answers questions, sleeps a lot. In severe cases, develops loss of consciousness and coma.
If you suspect a ketoacidosis, you should immediately show the patient to the doctors. Call an ambulance or take it to the hospital yourself.
Treatment of ketoacidosis
To confirm the diagnosis, doctors will do a blood test for sugar, pH, ketone bodies, electrolytes. A urine test will also be performed. The main treatment for diabetic ketoacidosis is insulin. In everyday life, people with diabetes inject this substance subcutaneously. But with ketoacidosis, such injections are ineffective. Intravenous insulin administration in small doses every hour is necessary. In addition, the patient will be assigned droppers to combat dehydration, drugs to normalize the concentration of salts in the blood and other medications according to the indications.
Hyperosmolar coma with diabetes
Hyperosmolar coma is an extreme degree of metabolic disorder in type 2 diabetes .In rare cases, this coma occurs with other types of diabetes. Typical is the elderly age of patients, concomitant diseases of the cardiovascular system. This coma is characterized by extremely high values of the concentration of glucose in the blood. At the same time, there is no disturbance of the acid-base balance of the blood. This means that the pH of the blood remains normal. There is also no excessive formation of ketone bodies and free fatty acids. Patients will not have a breath of acetone or deep noisy breathing in the exhaled air. In patients with hyperosmolar coma, there is expressed in the extreme degree of dehydration of the body .During the development of this emergency( and this is several days), the patient loses up to 10% of the body weight.
The mechanism of the development of coma is the emergence of relative insulin deficiency against the background of concomitant pathology and a sharp dehydration of the body. Blood sugar increases to values 5-10 times higher than normal. A small concentration of insulin at type 2 diabetes is always there, so fatty tissue is broken down a little. The products of its decay do not fill the blood. But the level of glucose in the blood is so high that it in itself acquires toxic properties in relation to the brain. Sugar is excreted in the urine. Since a person loses a lot of fluid, dehydration develops.
Provoke a hyperosmolar condition: vomiting, diarrhea, diuretics, bleeding, burns, fluid restriction, concomitant infectious processes, injuries, surgeries, systematic diet abnormality.
Even if type 2 diabetes is easy to cure, only diet and pills are enough, this does not mean that the patient is insured against hyperosmolar coma. In the elderly, any concomitant disease can significantly affect carbohydrate metabolism and provoke a worsening of diabetes.
If the patient can be suspected of hyperosmolar coma, then it must be immediately delivered to the hospital .
Treatment of hyperosmolar coma
Already under the conditions of the hospital, blood and urine tests will be performed. Will be prescribed treatment for the underlying disease and related pathology. The most important in the treatment of hyperosmolar state is the replacement of the volume of the lost fluid with the help of droppers. Also, insulin is administered intravenously in small doses every hour.
Lactate acidosis with diabetes
Lactate acidosis is an emergency that occurs with a sharp increase in the concentration of lactic acid in the body. With diabetes it is possible in elderly and senile patients with severe liver, kidney, heart, lung, or chronic alcoholism pathology. Lactic acid is formed in tissues during oxygen starvation. Severe diseases, especially the heart and lungs, provoke such a deficiency of oxygen.
In diabetes mellitus, lactic acidosis provokes the use of one of the hypoglycemic agents - metformin. This medicine promotes the formation of lactic acid in tissues. For doctors, the most important in the prevention of lactic acidosis is the justified use of metformin. And for patients it is recommended to completely abandon self-treatment and strictly follow the doctor's instructions.
Symptoms of lactate acidosis
The peculiarities of lactate acidosis manifestation are spilled muscular pains, chest pains, severe weakness, dyspnea at rest, abdominal pain, decreased performance .Lactate acidosis is accompanied by vomiting, nausea .The respiratory center is irritated by a high concentration of lactic acid, therefore arises a deep noisy breathing .There is no smell of acetone in the exhaled air.
Treatment of lactate acidosis
Diagnosis of the disease is carried out according to laboratory data. Determining analysis can be considered the definition of a sharply elevated level of lactate in the blood. The treatment of this coma is based on the introduction of alkaline solutions, other fluids and drugs that maintain blood pressure. In some cases, blood purification sessions are required using an artificial kidney apparatus.
Severe hypoglycemia in diabetes
Hypoglycemic coma is a coma associated with a sharp decrease in blood glucose. This is the most common of the urgent conditions in diabetes mellitus. More often it occurs in patients receiving insulin treatment, and is equally possible for any type of diabetes .
True hypoglycemia is a decrease in blood sugar below the level of 2.2-2.8 mM / L.Provokes such a drop in glucose drug overdose( for example, by forgetfulness or error), unplanned physical activity, skipping meals or eating without carbohydrates, and also alcohol in large quantities. Moreover, a dose of pure alcohol more than 20-40 ml is considered dangerous in terms of hypoglycemia.
Symptoms of hypoglycemic coma
Manifestations of hypoglycemia are associated with energy deficiency in the cells of the cerebral cortex and the release of a large number of stress hormones into the blood. Symptoms of hypoglycemia are headache, dizziness, numbness of the lips, tongue, anxiety, decreased concentration, feelings of fear, anxiety, speech disorders, convulsions, hunger, drooling, heart palpitations, irritability, trembling in the fingers, trembling in the body, coldsweat, nausea, vomiting, profuse urination, severe deterioration of vision .
Treatment of
At the first signs of hypoglycemia, the patient should help himself - to eat what is usually forbidden by the diet - sweet. It is best to drink warm tea with 2-3 tablespoons of sugar or a glass of fruit juice. You can also use lollipops, caramel, sugar or sugar refined sugar and other products on glucose or fructose. If the patient does not have time to take carbohydrates in time, then there is a loss of consciousness and development of coma .In this case, only a trained person can help. It is necessary to enter intravenously glucose solution or intramuscular glucagon solution. Severe hypoglycemia requires mandatory hospitalization in the hospital for examination, treatment and education.
Doctor of the endocrinologist Tsvetkova IG.