Hyperglycemic coma: emergency care, algorithm of actions, symptoms

Hyperglycemic coma (ICD-10 code E14.0) is the most severe and serious complication of a disease such as diabetes mellitus. This condition of the patient can be attributed to the last stage of metabolic disturbances.

Coma develops with a significant increase in the concentration of glucose in the blood (up to 30 units or more). In the vast majority of cases, it is observed in patients with type 1 diabetes. And the number of deaths varies from 5 to 30% percent.

There is a special classification of com. They differ in etiology and causes of development. Hyperglycemic coma develops most often in patients with type 2 diabetes. There is also a hypoglycemic coma. The main reason for its progression is a sharp decrease in the concentration of glucose in the patient’s blood.

Hyperglycemic ketoacidotic coma is characterized by ketoacidosis; during a hyperosmolar non-ketoacidotic state, there is a violation of fluid circulation in the human body; for hyperlactacidemic coma, the accumulation of lactic acid in the tissues and blood of the body is characteristic.

Causes and factors

The pathogenesis of hyperglycemic coma is based on an increase in sugar levels in the body and a violation of metabolic processes. If the patient produces enough insulin, the coma will not develop.

In cases where glucose exceeds 10 units, it already penetrates into the patient’s urine. As a result, complications develop. 

Conventionally, the following reasons for the development of hyperglycemic coma can be distinguished:

• Wrong dosage of insulin, missed injection.
• Stressful situation, nervous tension.
• Persistent decompensation of the disease.
• History of myocardial infarction or stroke.
• Infectious diseases of the respiratory system, brain and other life support systems of the body.
• Violation of a wellness diet, alcohol abuse.
• Pregnancy.
• Change from one hypoglycemic drug to another.

During pregnancy, the female body functions with a double load. In the case when the expectant mother has a latent form of pathology, then a lethal outcome is not excluded.

In a situation where diabetes mellitus is diagnosed before pregnancy, it is necessary to control the level of glucose in the body, and in case of any negative symptoms, contact your doctor.

In the vast majority of cases, hypoglycemic coma is diagnosed in patients with diabetes mellitus who have administered an excessively large dosage of insulin or a hypoglycemic agent.

Hypoglycemia can result from intense physical exertion or fasting.

Clinical picture

A hyperglycemic coma can develop from one to three days, but its occurrence is not excluded within a few hours. Nevertheless, in 99% of cases, the prerequisites for coma are observed several days before its development.

How to recognize pathology? The characteristic signs of hyperglycemic coma are impaired appetite, bouts of nausea and vomiting, dry mouth, feeling of constant thirst. 

A feature is also the fact that the patient may experience shortness of breath, weakness, apathy, sleep disturbance (most often drowsiness), and a decrease in blood pressure. Most often, this condition develops rather slowly, therefore, diagnostic measures and prehospital care are often carried out out of time.

Hyperglycemic diabetic coma is dangerous in that it is very easy to confuse it with ordinary food poisoning, as a result of which the condition progresses, and the patient only feels worse. Development of more serious consequences, up to and including death, is possible.

Hypo and hyperglycemic coma have significant differences in symptoms. A hypoglycemic coma is almost always characterized by an acute onset. Pathology can be characterized by the following symptoms:

1. Rapidly growing weakness.
2. Rapid heartbeat.
3. Unreasonable and intense feeling of fear.
4. Feeling hungry, chills, dizziness.
5. Profuse sweating.

If there is at least one of the signs of such a complication, you must immediately check the glucose in your blood. In comparison with hyperglycemic coma, hypoglycemia develops more rapidly. This condition is also extremely life-threatening for the patient.

The development of a coma in a child

Most often, young patients develop a ketoacidotic coma, which requires treatment exclusively in a hospital setting.

The causes of hyperglycemic ketoacidotic coma are virtually the same. However, hormonal and mental instability is added to them, which are characteristic precisely for childhood and adolescence.

A hyperglycemic diabetic coma in a child develops relatively slowly, over several days. If a small amount of insulin is injected, a violation of the glucose utilization processes is observed.

Symptoms in childhood begin with mild malaise and end in severe deterioration. Signs of hyperglycemic coma:

• Initially, there are signs of general malaise, weakness and rapid fatigue, drowsiness. Sometimes children complain of impaired auditory perception, nausea and a constant feeling of thirst.
• Further, nausea turns into vomiting, and failure to provide assistance leads to pain in the abdomen, inhibited reaction and pain in the heart.
• At the last stage, the child speaks indistinctly, may not answer questions, breathes deeply and noisily, and the smell of acetone is detected from the oral cavity. The final is loss of consciousness. When taking tests, acetone is observed in the blood. 

Hyperglycemic diabetic coma requires immediate medical attention, since its untimely provision can be fatal.

Algorithm of emergency care for hyperglycemic coma

Relatives of a diabetic should know exactly what the clinic and emergency care for diabetic coma is. You need to be able to distinguish between hypo- and hyperglycemic states.

What should be done before the ambulance arrives? Carrying out care for hyperglycemic coma involves administering insulin subcutaneously at intervals of 2-3 hours. The dosage is adjusted depending on the glucose content in the body. Glycemia should be measured every hour.

Limit carbohydrate intake without fail. In the treatment of hyperglycemic coma, drugs are used that include potassium and magnesium, as they help prevent hyperacidosis.

In the case when two doses of insulin at equal intervals did not have the required therapeutic effect, the symptoms did not change, and the patient’s condition did not stabilize, an ambulance must be called.

In a situation where a diabetic is in too serious a condition, and he is almost on the verge of losing consciousness, urgent help will be needed. However, intensive treatment of a coma takes place in a hospital setting. 

First aid first aid for hyperglycemic coma consists of the following actions:

1. The patient is placed on his side so that he does not choke on vomit. Also, this position allows you to exclude tongue sinking.
2. The patient is covered with several warm blankets.
3. It is imperative to control the pulse and breathing.

If the patient has lost breathing, it is necessary to immediately begin resuscitation, artificial respiration and heart massage.

All types of coma are extremely serious complications, an emergency and timely call to an ambulance will help increase the chances of a favorable outcome. If family members have a history of diabetes mellitus, then every adult household member should understand that adequate help will prevent a developing crisis and save the patient.

Important: you must be able to distinguish hyperglycemia from hypoglycemia. In the first case, insulin is injected, and in hypoglycemic coma, glucose is injected.

Prevention

Hyperglycemic diabetic coma is a serious complication, but it can be avoided if you follow all the doctor’s recommendations and lead a healthy lifestyle. Sometimes this condition develops in people who are not even aware of the presence of diabetes. Therefore, it is very important to undergo a comprehensive differential diagnosis when characteristic symptoms of autoimmune pathology appear.

Analysis for glycated hemoglobin, analysis for blood sugar (fasting), glucose tolerance test, ultrasound of the pancreas, urinalysis for sugar will allow timely identification of type 1 or 2 diabetes, and prescribe the appropriate treatment tactics.

To avoid hyperglycemic coma, diabetics need:

• When diagnosed with type 1 diabetes mellitus, carefully monitor your condition before and after insulin injections. If, after the administration of the hormone, the glycemic level exceeds the mark of 10-15 mmol / l, then an adjustment of the treatment regimen will be required. Your healthcare professional may prescribe a different type of insulin. The most effective and safest is human insulin.
• With type 2 diabetes, the patient must strictly follow the diet. If you are obese, a low-carb diet is indicated.
• To live an active lifestyle. Moderate physical activity will increase the sensitivity of tissues to insulin, and improve the general condition of the patient.
• Take hypoglycemic drugs (with type 2 diabetes), and do not self-adjust the dosage.

It is also recommended that patients undergo regular preventive examinations. Doctors recommend monitoring the glycemic profile and the overall dynamics of the disease. To take measurements at home, you need to use an electrochemical glucometer. 

It is equally important to monitor the level of glycated hemoglobin. Below is a table of correspondence of glycated hemoglobin to the average daily sugar level.