2023 Author: Josephine Shorter | [email protected]. Last modified: 2023-05-24 11:52
Definition of hyperglycemic coma
Hyperglycemic coma is the most severe and life-threatening complication of diabetes mellitus. It develops as a result of an increase in insulin deficiency and a significant decrease in the utilization of glucose in the blood.
In the body of a sick person, a profound metabolic disorder occurs with the formation of a large number of ketone bodies, with the development of acidosis (violation of the acid-base balance), with intoxication of the central nervous system.
Signs of developing hyperglycemic coma
Hyperglycemic coma is characterized by gradual development over several hours or days. The forerunners of its formation, the so-called prodromal period, are headache, weakness, apathy, drowsiness, and intense thirst.
Often the patient is worried about nausea, accompanied by vomiting. After a few hours or days, the smell of acetone appears from the mouth, shortness of breath, accompanied by very deep, frequent and noisy breathing. After this, there is a disturbance of consciousness up to its complete loss and the development of a coma itself.
Reasons for the development of hyperglycemic coma
The reasons for the development of hyperglycemic coma include untimely diagnosed diabetes mellitus, improper treatment, insufficient insulin administration, below the dose prescribed by the doctor, violation of the diet in diabetes mellitus, infections of various nature, mental trauma, surgery, stress. This complication practically does not occur in type 2 diabetes mellitus.
Symptoms of the development of hyperglycemic coma
The development of hyperglycemic coma is accompanied by a complete or partial impairment of consciousness, severe hyperemia (redness) of the face, dry skin and mucous membranes, a sharp smell of acetone from the mouth, a decrease in turgor (tension of the skin and fat folds) of the skin and muscle tone.
The patient's tongue is dry and coated with a dark brown coating. Reflexes are often slowed down, the eyeballs are sunken, soft. Kussmaul's breathing is deep, noisy, not quickened. There are violations of the cardiovascular system, renal dysfunction - first polyuria (an increase in the amount of urine excreted per day), then oliguria (a decrease in the amount of urine excreted) and anuria or complete absence of excreted urine.
Blood pressure is lowered, pulse is frequent, threadlike, body temperature is below normal. In the urine, ketone bodies are determined, in the blood - hyperglycemia. If during this period the patient does not receive emergency qualified assistance, he may die.
Consequences of the development of hyperglycemic coma
From the first minutes of the development of a diabetic coma, there is a danger that the patient may choke on his own vomit or suffocate due to the sinking of the tongue.
At the last stage, dysfunctions of all vital organs and systems of the body are pronounced, which can lead to the death of the patient. There is a failure of all types of exchange. From the side of the central nervous system, there is a disruption in the functioning of the brain, expressed in loss of consciousness up to its complete suppression, most often occurs in the elderly and threatens the possibility of paralysis, paresis, and a decrease in mental abilities. Reflexes decrease or disappear completely. The urinary system also suffers, the amount of urine excreted decreases up to a complete absence. With a predominant lesion of the cardiovascular system, blood pressure drops, which can lead to myocardial infarction, the development of vascular thrombosis and further to trophic ulcers and gangrene.
Emergency first aid
Basically, patients with diabetes mellitus are informed about the possibility of developing hyperglycemic or diabetic coma. Therefore, if the patient's condition allows, it is recommended to find out from him and provide him with all possible assistance: if there is insulin, help the patient to introduce it.
If the patient is unconscious, then before the arrival of the ambulance, it is recommended to provide free airway, to monitor the pulse. It is necessary to free the oral cavity from removable prostheses, if any, to turn the patient on its side to prevent him from choking on vomit in case of vomiting and to avoid tongue sinking.
At the first signs of coma development, it is necessary to immediately contact a medical institution to stop the crisis and its further treatment, this condition requires urgent emergency qualified help. But in all cases, you should immediately seek professional medical help.
Article author: Mochalov Pavel Alexandrovich | d. m. n. therapist
Education: Moscow Medical Institute. IM Sechenov, specialty - "General Medicine" in 1991, in 1993 "Occupational Diseases", in 1996 "Therapy".