Diabetic coma - Causes, Symptoms and Treatment .MF .

August 12, 2017 17:52 | Emergencies

Diabetes - a widespread chronic disease characterized by metabolic disorders.Diabetes is dangerous not only late complications (damage to nerve tissue, blood vessels, liver, kidney), and acute conditions (coma).Emergency conditions in diabetes are diverse in terms of the causes and mechanisms of their origin.Coma may be associated with low blood glucose levels, or, conversely, to be a background of hyperglycemia (high blood sugar).Currently, there are three variants of diabetic coma with elevated levels of blood glucose (diabetic ketoacidosis, hyperosmolar coma, lactic acidosis) and hypoglycemic someone with low sugar.

Diabetic ketoacidosis Diabetic ketoacidosis

- it is actually extremely difficult stage of metabolic disorders in type 1 diabetes .In rare cases, the coma may be in a patient with type 2 disease.

reason for this urgency is the state of almost complete lack of insulin in the body.This situation happens when later diagnosed type 1 diabetes.In this case, its secretion of insulin in the b

ody is impossible because of the destruction of beta cells in the pancreas, and the treatment is not carried out, since the diagnosis is not yet installed.Late diagnosed diabetes usually in young adult patients who are prone to carry any diseases on the feet and not pay attention to the malaise.Furthermore, after 18 processes destruction of beta cells are slower than in childhood, which means that diabetes and progresses more slowly, which allows a person to adapt to life long disease.Ultimately, such a patient the patient immediately gets to the hospital by ambulance, bypassing the stage of examination in the clinic.

also violations of the treatment of type 1 diabetes lead to the development of ketoacidosis.Such typical errors can be attributed to use expired insulin or improper storage, failure in the systems of administration of insulin (pen, pump), an incorrect calculation of insulin dose by the number of carbohydrates.In some cases, ketoatsidaticheskaya coma occurs when unauthorized cancellation of insulin.The idea to refuse treatment to the patient can come under the influence of negative public opinion on insulin injections or after studying pseudoscientific techniques on the Internet, promising a cure for type 1 diabetes. Waiver of insulin in this disease in a few days leads to the development of diabetic coma ketoatsidoticheskaya.

severe concomitant diseases (infection, inflammation, heart attacks, strokes) also lead to the development of such a coma.

Symptoms of ketoacidosis

Development Mechanism ketoacidosis is composed of several units.In the absence of insulin dramatically increases blood sugar levels.Excess glucose begins eliminated via the kidneys, and taking with them a large amount of liquid.This leads to severe dehydration. patient often goes to the toilet and drink plenty of water every hour.The skin and mucous membranes become dry, lose their elasticity. in sugar tissue can not penetrate, so the inside of the cell as an energy material reserves of fat consumed. patient begins to rapidly lose weight .In the decay of adipose tissue, a large amount of ketone bodies and free fatty acids.These substances accumulate in large amounts in the blood.Changing the acid-base balance of the blood.The acid irritates the respiratory center in the blood. The person has shortness of breath or noisy breathing deeply. breath an admixture of ketone bodies.In the room where the patient feels smell of acetone.

Ketoacidosis develops within a few days, sometimes hours.Gradually, the patient's condition changes.As the progression of severe complications of the patient becoming less sociable, monosyllabic answers to questions, a lot of sleeping. In severe cases, loss of consciousness develops and coma.

If you suspect ketoacidosis need to immediately show the patient's doctors. Call an ambulance or take him to the hospital on their own.

Treatment ketoacidosis

To confirm the diagnosis, doctors do a blood test for sugar, pH, ketone bodies, electrolytes.There will also be a study of urine.The main treatment for diabetic ketoacidosis is insulin.In everyday life, people with diabetes are administered this substance subcutaneously.But ketoacidosis such injections are ineffective.It is necessary to intravenous insulin in small doses every hour.In addition, the patient will be assigned to drip to combat dehydration, medication to normalize the concentration of salts in the blood and other medications may be needed.

hyperosmolar coma in diabetes

hyperosmolar coma - an extreme degree of metabolic with type 2 diabetes .In rare cases, this coma occurs in other types of diabetes.Typical is an older patient age, concomitant diseases of the cardiovascular system.For this coma exhibiting extremely high concentrations of glucose in the blood.At the same time violations of the acid-base balance of blood does not occur.This means that the blood pH remains normal.Also, there is no excessive formation of ketone bodies and free fatty acids.Patients will not breath odor of acetone noisy or deep breathing.Patients are able to hyperosmolar coma has expressed in extreme dehydration body.During the development of the state of emergency (which is a few days), patient loses up to 10% body weight.

The mechanism of occurrence of coma is relative deficiency of insulin in the background of comorbidity and sudden dehydration.Blood sugar rises to values ​​of 5-10 times higher than normal.A small concentration of insulin in type 2 diabetes, there is always so little fat tissue is split.The products of its decay is not filled with blood.However, the blood glucose level is so high that it becomes in itself toxic properties with respect to the brain.Sugar is excreted in the urine.Since a person loses a lot of liquid, then developing dehydration.

provoke hyperosmolar state: vomiting, diarrhea, diuretics, bleeding, burns, fluid restriction, associated infectious processes, trauma, surgery, systematic violations of diet.

Even if type 2 diabetes is mild, enough to treat only diet and tablets, it does not mean that the patient is safe from giperosmolyanoy coma.In old age, any concomitant disease can significantly impact on carbohydrate metabolism and cause worsening of diabetes.

If the patient can be suspected hyperosmolar coma, it must be immediately delivered to the hospital .

Treatment hyperosmolar coma

already in a hospital will be carried out blood tests and urine tests.treatment will be the main disease and comorbidity.The most important in the treatment of hyperosmolar state is considered replenishing lost fluid volume with droppers.insulin therapy is also carried out in small doses intravenously every hour.

lactic acidosis in diabetes

lactic acidosis - a medical emergency that occurs when a sharp increase in the concentration of lactic acid in the body.In diabetes it is possible in patients with middle and old age, suffering from severe liver disease, kidney, heart, lung, or chronic alcoholism.Lactic acid is formed in the tissues of oxygen starvation.Severe illness, especially the heart and lungs, provoking a lack of oxygen.

In diabetes lactic acidosis stimulates the use of one of hypoglycemic agents - metformin.This drug promotes the formation of lactic acid in the tissues.For doctors the most important in the prevention of lactic acidosis is only reasonable metformin.A patient is recommended to completely give up self and strictly follow the doctor's instructions.

Symptoms of lactic acidosis

features of display of lactic acidosis are considered spilled muscle pain, chest pain, severe weakness, shortness of breath at rest, abdominal pain, decreased performance.Lactic acidosis is accompanied vomiting, nausea .Respiratory Center provoked a high concentration of lactic acid, so there is noisy breathing deeply .Odor of acetone is no breath.

treatment of lactic acidosis

Diagnosis of the disease is carried out according to laboratory studies.The decisive analysis can be considered as the definition of sharply increased levels of lactate in the blood.Treatment of the coma is based on the introduction of alkaline solutions, medicines and other fluids to maintain blood pressure.In some cases, sessions are required blood purification using an artificial kidney machine.

Severe hypoglycemia in diabetes

Hypoglycemic coma - a coma, associated with a sharp decline in blood glucose levels.This is the most frequent states of emergency in diabetes.Most often it occurs in patients receiving insulin treatment, and it is equally possible with any type of diabetes .

True hypoglycemia is a reduction in blood sugar below the 2.2-2.8 mmol / l.It provokes a drop in glucose overdose of drugs (such as forgetfulness or error), unplanned exercise, skipping meals or eating no carbohydrates, and alcohol in large enough quantities.Moreover, the dose of pure alcohol a 20-40 ml is considered to be dangerous in terms of hypoglycaemia.

symptoms of hypoglycemic coma

manifestations of hypoglycemia associated with deficiency of energy in the cells of the cerebral cortex and releasing large amounts of stress hormones in the blood.Signs of hypoglycemia is headache, dizziness, numbness of the lips, tongue, restlessness, poor concentration, feelings of fear, anxiety, speech disorders, convulsions, hunger, excessive salivation, palpitations, irritability, tremors in the fingers, tremors, coldperspiration, nausea, vomiting, excessive urination, sudden loss of vision .

Treatment At the first sign of hypoglycemia patient should help themselves - consume food that is usually forbidden diet - sweet.It is best to drink hot tea with 2-3 tablespoons of sugar and a glass of fruit juice.It is also possible to use candy, caramel, sugar or refined sugar and other products on glucose or fructose. If the patient does not have time time to take carbohydrates, then there is a loss of consciousness and coma development.In this case, assistance can only be prepared by a person.It is necessary to introduce a solution of glucose intravenously or intramuscularly glucagon solution.Severe hypoglycemia requires mandatory hospitalization for examination, treatment and education.

endocrinologist Tsvetkova IG