Diabetic coma
From Wikipedia, the free encyclopedia
This article does not cite any references or sources. Please help
improve this article by adding citations to reliable sources. Unverifiable
material may be challenged and removed. (April 2007)
This section may require cleanup to meet Wikipedia's quality standards.
Diabetic coma is a medical emergency in which a person with diabetes mellitus is
comatose (unconscious) because of one of the acute complications of diabetes:
1. Severe diabetic hypoglycemia
2. Diabetic ketoacidosis advanced enough to result in unconsciousness from a
combination of severe hyperglycemia, dehydration and shock, and exhaustion
3. Hyperosmolar nonketotic coma in which extreme hyperglycemia and dehydration
alone are sufficient to cause unconsciousness.
In most medical contexts, the term diabetic coma refers to the diagnostical
dilemma posed when a physician is confronted with an unconscious patient about
whom nothing is known except that he has diabetes. An example might be a
physician working in an emergency department who receives an unconscious patient
wearing a medical identification tag saying DIABETIC. Paramedics may be called
to rescue an unconscious person by friends who identify him as diabetic. Brief
descriptions of the three major conditions are followed by a discussion of the
diagnostic process used to distinguish among them, as well as a few other
conditions which must be considered.
An estimated 2 to 15 percent of diabetics will suffer from at least one episode
of diabetic coma in their lifetimes as a result of severe hypoglycemia.
Diabetes mellitus
Types of Diabetes
Diabetes mellitus type 1
Diabetes mellitus type 2
Gestational diabetes
Pre-diabetes:
Impaired fasting glycaemia
Impaired glucose tolerance
Disease Management
Diabetes management:
•Diabetic diet
•Anti-diabetic drugs
•Conventional insulinotherapy
•Intensive insulinotherapy
Other Concerns
Cardiovascular disease
Diabetic comas:
•Diabetic hypoglycemia
•Diabetic ketoacidosis
•Nonketotic hyperosmolar
Diabetic myonecrosis
Diabetic nephropathy
Diabetic neuropathy
Diabetic retinopathy
Diabetes and pregnancy
Blood tests
Blood sugar
Fructosamine
Glucose tolerance test
Glycosylated hemoglobin
Contents
[hide]
* 1 Severe hypoglycemia
* 2 Advanced diabetic ketoacidosis
* 3 Nonketotic hyperosmolar coma
* 4 Identifying the cause of diabetic coma
* 5 Treatment options for Diabetic Coma
* 6 References
* 7 See also
[edit] Severe hypoglycemia
People with type 1 diabetes mellitus who must take insulin in full replacement
doses are most vulnerable to episodes of hypoglycemia. It is usually mild enough
to reverse by eating or drinking carbohydrates, but blood glucose occasionally
can fall fast enough and low enough to produce unconsciousness before
hypoglycemia can be recognized and reversed. Hypoglycemia can be severe enough
to cause unconsciousness during sleep. Predisposing factors can include eating
less than usual, prolonged exercise earlier in the day, and heavy drinking. Some
people with diabetes can lose their ability to recognize the symptoms of early
hypoglycemia.
Unconsciousness due to hypoglycemia can occur within 20 minutes to an hour after
early symptoms and is not usually preceded by other illness or symptoms.
Twitching or convulsions may occur. A person unconscious from hypoglycemia is
usually pale, has a rapid heart beat, and is soaked in sweat: all signs of the
adrenaline response to hypoglycemia. The individual is not usually dehydrated
and breathing is normal or shallow. A meter or laboratory glucose at the time of
discovery is usually low, but not always severely, and in some cases may have
already risen from the nadir that triggered the unconsciousness.
Unconsciousness due to hypoglycemia is treated by raising the blood glucose with
intravenous glucose or injected glucagon.
Advanced diabetic ketoacidosis
Diabetic ketoacidosis (DKA), if it progresses and worsens without treatment, can
eventually cause unconsciousness, from a combination of severe hyperglycemia,
dehydration and shock, and exhaustion. Coma only occurs at an advanced stage,
usually after 36 hours or more of worsening vomiting and hyperventilation.
In the early to middle stages of ketoacidosis, patients are typically flushed
and breathing rapidly and deeply, but visible dehydration, pallor from
diminished perfusion, shallower breathing, and rapid heart rate are often
present when coma is reached. However these features are variable and not always
as described.
If the patient is known to have diabetes, the diagnosis of DKA is usually
suspected from the appearance and a history of 1-2 days of vomiting. The
diagnosis is confirmed when the usual blood chemistries in the emergency
department reveal hyperglycemia and severe metabolic acidosis.
Treatment of DKA consists of isotonic fluids to rapidly stabilize the
circulation, continued intravenous saline with potassium and other electrolytes
to replace deficits, insulin to reverse the ketoacidosis, and careful monitoring
for complications.
Nonketotic hyperosmolar coma
Nonketotic hyperosmolar coma usually develops more insidiously than DKA because
the principal symptom is lethargy progressing to obtundation, rather than
vomiting and an obvious illness. Extreme hyperglycemia is accompanied by
dehydration due to inadequate fluid intake. Coma from NKHC occurs most often in
patients who develop type 2 or steroid diabetes and have an impaired ability to
recognize thirst and drink. It is classically a nursing home condition but can
occur in all ages.
The diagnosis is usually discovered when a chemistry screen performed because of
obtundation reveals extreme hyperglycemia (often above 1800 mg/dl (100 mM)) and
dehydration. The treatment consists of insulin and gradual rehydration with
intravenous fluids.
Identifying the cause of diabetic coma
Diabetic coma was a more significant diagnostic problem before the late 1970s,
when glucose meters and rapid blood chemistry analyzers became universally
available in hospitals. In modern medical practice, it rarely takes more than a
few questions, a quick look, and a glucose meter to determine the cause of
unconsciousness in a patient with diabetes. Laboratory confirmation can usually
be obtained in half an hour or less. Also, the astute physician remembers that
other conditions can cause unconsciousness in a person with diabetes: stroke,
uremic encephalopathy, alcohol, drug overdose, head injury, or seizure.
Fortunately, most episodes of diabetic hypoglycemia, DKA, and extreme
hyperosmolarity do not reach unconsciousness before a family member or caretaker
seeks medical help.
Treatment options for Diabetic Coma
Ketoacidotic Diabetic Coma : intravenous fluids, insulin and administration of
potassium and sodium.
Hyperosmolar Diabetic Coma : plenty of intravenous fluids, insulin, potassium
and sodium given as soon as possible.
Hypoglycaemic Diabetic Coma : administration of the hormone glucagon to reverse
the effects of insulin, or glucose given intravenously.
[1]
References
1. ^ Diabetic Coma
See also
* Diabetic hypoglycemia
* Diabetic ketoacidosis
* Nonketotic hyperosmolar coma
[hide]
v • d • e
Endocrine pathology: endocrine diseases (E00-35, 240-259)
Pancreas/
glucose
metabolism
Diabetes mellitus types: (type 1, type 2, MODY), complications: (coma,
angiopathy, ketoacidosis, nephropathy, neuropathy, retinopathy, cardiomyopathy)
Hypoglycemia · Hyperinsulinism · Zollinger-Ellison syndrome · insulin receptor (Rabson-Mendenhall
syndrome) · Insulin resistance
Hypothalamic/
pituitary axes
Pituitary
Hyperpituitarism (Acromegaly, Hyperprolactinaemia, SIADH)
Hypopituitarism (Sheehan's syndrome, Kallmann syndrome, Growth hormone
deficiency, Diabetes insipidus)
Adiposogenital dystrophy · Empty sella syndrome · Pituitary apoplexy · ACTH
deficiency
Thyroid
Hypothyroidism (Iodine deficiency, Cretinism, Congenital hypothyroidism, Goitre,
Myxedema)
Hyperthyroidism (Graves disease, Toxic multinodular goitre, Teratoma with
thyroid tissue or Struma ovarii)
Thyroiditis (De Quervain's thyroiditis, Hashimoto's thyroiditis, Riedel's
thyroiditis)
Euthyroid sick syndrome · Thyroid hormone resistance · Thyroid nodule
Parathyroid
Hypoparathyroidism (Pseudohypoparathyroidism) · Hyperparathyroidism (Primary,
Secondary, Tertiary)
Adrenal
Adrenocortical hyperfunction: Cushing's syndrome (Nelson's syndrome,
Pseudo-Cushing's syndrome) · Hyperaldosteronism (Conn syndrome, Bartter
syndrome) · Glucocorticoid remediable aldosteronism
CAH (Lipoid, 3β, 11β, 17α, 21α)
Adrenal insufficiency (Addison's disease, Waterhouse-Friderichsen syndrome) ·
Hypoaldosteronism
Gonads
ovarian (Polycystic ovary syndrome, Premature ovarian failure)
testicular (5-alpha-reductase deficiency, 17-beta-hydroxysteroid dehydrogenase
deficiency) · Androgen receptor (Androgen insensitivity syndrome)
general (Hypogonadism, Delayed puberty, Precocious puberty)
Height
Gigantism · Dwarfism/Short stature (Laron syndrome, Psychogenic dwarfism)
Thymus
Abscess of thymus · Thymus hyperplasia
Multiple
Autoimmune polyendocrine syndrome · Carcinoid syndrome · Multiple endocrine
neoplasia (1, 2) · Progeria · Woodhouse-Sakati syndrome
see also congenital, neoplasia
Retrieved from "http://en.wikipedia.org/wiki/Diabetic_coma"
Categories: Medical emergencies | Diabetes
Hidden categories: Articles lacking sources from April 2007 | All articles
lacking sources | Cleanup from April 2008 | All pages needing cleanup
* This page was last modified on 15 October 2008, at 03:53.
* All text is available under the terms of the GNU Free Documentation License.
(See Copyrights for details.)