Hyperosmolar coma Diabetic ketoacidosis is different from another acute diabetes complications, mainly seen in the age of 50 with type 2 diabetes, with up to 50% of patients without a clear history of diabetes, only this as the first performance, in a certain incentives, such as infection, under the facilitation of glucose metabolism in the short term a serious disorder, blood sugar is too high, there consciousness disorder and severe dehydration, serious consequences and poor prognosis. Tianjin Metabolic Diseases Hospital, said Professor Yu Demin, hyperosmolar coma while dangerous, but the usual attention to self-care, is entirely preventable and treatable.

Incentives

In the absence of insulin, based on some common factors that can induce diabetic hyperosmolar coma, these factors include:

Stress: The most common infection, especially lung infections, urinary tract infection, gastroenteritis, septicemia, etc., in a number of factors could account for 2 / 3. In addition, including trauma, surgery, myocardial infarction, gastrointestinal bleeding, stroke and so on.

Water shortage: more common in the elderly decreased sensitivity to thirst center, life can not take care of themselves, or coma patients.

Excessive water loss: such as fever, severe vomiting, diarrhea, high intake of sugars; to drink a lot of high sugar drinks or intravenous high-sugar, etc..

Drugs: a large number of taking drugs affecting glucose metabolism, such as: adrenal cortex hormones, diuretics, propranolol, cimetidine, wintermine so.

In recent years, the increasing popularity of the application of insulin pumps, there are individual patients are not promptly check the hidden problems, such as catheter blockage can lead to the disease.

Sometimes in the same time, the presence of several factors induced diabetic hyperosmolar coma.

Place

This disease is the lack of context in insulin, coupled with the presence of these incentives result. Patients with a lack of insulin itself, the existence of incentives to make it heavier, resulting in elevated blood sugar, high blood sugar lead to osmotic diuresis, loss of body water and electrolytes such as potassium, sodium, and water loss greater than the loss of sodium potassium loss; At the same time, body compensatory function of the corresponding decrease (decreased sensitivity to thirst center, to reduce the release of antidiuretic hormone, ADH), blood concentration, resulting in reduction of renal blood flow, glucose and sodium to reduce exclusion, promote blood sugar, serum sodium increased further, causing a vicious circle, resulting in a severe dehydration, and there are different levels of consciousness.

Features

Patients with more than 60 years of age or older, 2 / 3, history of diabetes.

Onset more slowly, the first 3 to 5 days have prodromal symptoms such as thirst, polydipsia, polyuria increased, or there gastrointestinal symptoms such as nausea and vomiting.

Water loss in patients with obvious signs: weight loss, enophthalmos, skin dry fast and thin veins and so on.

Symptoms of central nervous system damage: such as hemiplegia, hemianopia, limitations convulsions, epilepsy, aphasia and so on.

Symptoms of incentives: if the lung infection, urinary tract infections.

Complications

If not timely diagnosis and treatment of this disease, condition aggravated, serious consequences, there may be a series of complications: such as blood clots, circulation disorder, heart failure, renal failure, respiratory failure, respiratory distress syndrome, stress ulcer gastrointestinal bleeding caused by , Disseminated intravascular coagulation (DIC), cerebral edema, cerebrovascular accident, serious arrhythmia, conduction block and so on, these are the performance of multiple organ failure, multi-occurred in coma patients.

Prevention

Elderly patients with diabetes self-care to enhance the awareness of effective treatment of diabetes and impaired glucose tolerance (IGT), strict control of blood glucose. If there is thirst, polydipsia, polyuria increased, or there gastrointestinal symptoms such as nausea, vomiting and other symptoms that required immediate treatment, regular treatment.

Should pay attention to drinking water to prevent dehydration. Note that restrictions on the consumption of sugary drinks.

Prevent all infections, stress and so on.

Or used with caution in elderly patients with diabetes do not have dehydration and elevated blood sugar drugs, such as furosemide (furosemide), Hydrochlorothiazide (Hydrochlorothiazide), phenytoin, glucocorticoids (prednisone, etc.), propranolol (propranolol). In the application of dehydration treatment, including kidney dialysis treatment should be close monitoring of blood glucose, blood osmotic pressure and urine output.

Prognosis

Poor prognosis of this disease, the mortality rate as high as 40% to 70%, the following factors influencing the prognosis:

The higher the age the greater the mortality. Statistics found that of those who died more than 60 years of age.

Prior to the onset of diabetes chronic complications, high mortality, including diabetes, kidney disease, coronary heart disease, cerebral infarction, hypertension, Gandan Bing, chronic bronchitis and emphysema.

The longer the coma, the higher mortality rate.

From severe infection, myocardial infarction, cerebrovascular accidents, etc. hyperosmolar coma induced by a higher death rate.

Were not timely medical treatment, the incidence more than 4 ~ 6 hours for treatment by a high mortality rate.

(1) Due to lack of O.2 and shock caused by the state. Such as: ① shock. Due to myocardial infarction, heart failure, severe trauma, infection, bleeding caused by cardiac, infection, blood loss, dehydration shock. ② hypoxia asphyxia. Carbon monoxide poisoning, pulmonary embolism and infarction. ③ acute pancreatitis with shock.

(2) No state of hypoxia and shock caused by those. Found: ① drugs. Biguanide hypoglycemic agents, especially those caused by phenformin more common and severe. In addition: ethanol, methanol, xylitol, sorbitol, fructose, paracetamol, salicylic acid salts, streptozotocin, catecholamines, cyanide category, isoniazid, ethylene glycol can cause. ② systemic disease. Diabetic ketoacidosis may be associated with this disease, liver disease, kidney failure uremia, malignant tumors, leukemia, severe infection with sepsis, convulsions, anemia, hunger can cause this disease. ③ genetic disease. Glucose -6 – phosphate dehydrogenase deficiency, fructose 1,6 – dioxo-acid enzyme deficiency, the lack of pyruvate carboxylase, pyruvate dehydrogenase deficiency, oxidative phosphorylation defects may also cause this disease.

Because this disease death rate is high, so to strengthen the prevention measures are as follows: Where a liver and kidney dysfunction, better not biguanide hypoglycemic agents, diabetes, heart disease heart failure-prone, kidney circulation disorder may also affect the biguanide drug excretion, it should be used with caution; avoid the use of ethanol, methanol, xylitol, salicylic acid salts, isoniazid and other drugs, propranolol and other drugs be used with caution; as far as possible without fructose, sorbitol and the use of glucose, in order to avoid this disease ; where there is shock, hypoxia, liver and renal failure, acidosis state, shall be to correct hypoxia, ischemia, shock to correct the basic measures to prevent the occurrence of this disease.

① a variety of infections and stress factors such as surgery, cerebrovascular accidents, especially those infected with diabetic hyperosmolar coma accounted for a variety of incentives to the top.

② caused by hyperglycemia in a variety of drugs such as glucocorticoids, a variety of diuretics, phenytoin, propranolol, particularly diuretics, such as Hydrochlorothiazide, furosemide, etc. not only increase the water loss, but also inhibit insulin release and to reduce the role of insulin sensitivity.

③ too much sugar or sodium intake, such as losing a large number of intravenous glucose, nasal feeding and even a large number of high nutritional drink orange juice can trigger this disease.

④ affect glucose metabolism in endocrine diseases such as hyperthyroidism, Acromegaly psychosis.

(2) all caused by water loss, dehydration factor. Such as:

① a variety of diuretics.

② insufficient water intake, such as hunger, restrictions on diet or vomiting, diarrhea, especially the elderly because of its central sense of thirst is not sensitive to the amount of water into the water shortages caused by poor more.

③ neurological or neurosurgical treatment of patients with dehydration.

④ dialysis, including hemodialysis or peritoneal dialysis patients.

⑤ burn patients.

(3) uremia patients with renal insufficiency. Including acute and chronic renal failure, diabetes and kidney, as glomerular filtration rate fall in blood glucose clearance rate has dropped, along with significantly higher blood glucose dehydration Er Shi.

Interpretation

In the cities, the mortality rate of diabetic patients may be as high as 125.06/10 10000. Particularly high in the age group of middle-aged diabetic patients complicated by cardiovascular disease, of which coronary heart disease as the main cause of death.

But when it comes cause of death would have referred to the acute complications of diabetes – hyperosmolar non-ketotic coma. Because, although its incidence is not high, only 2.45%, equivalent to diabetic chronic complications (coronary heart disease, cerebrovascular disease, kidney disease, and ketoacidosis, etc.) the incidence of 1 / 4 to 1 / 9 , but it was diabetes (especially among older patients with diabetes) and more life-threatening.

Hyperosmolar non-ketotic coma (hyperosmolar coma for short), for diabetes, a rare and serious acute complications. Disease is more common in elderly patients with diabetes. Its clinical features are severe high blood sugar, high plasma osmotic pressure, severe dehydration, no or mild ketosis, accompanied by varying degrees of nervous system disorder, or coma-based clinical syndrome. Disease mortality was high, in the past as much as 40% ~ 70%. In recent years, due to increased vigilance and awareness of the disease, positive early diagnosis and prompt treatment, mortality decreased significantly, but still as high as 15% ~ 20%. Faced with such a high mortality rate, we must emphasize the early and timely diagnosis and effective treatment.

Common incentives: ① infections (especially respiratory and urinary tract infections), cerebrovascular accident, pancreatitis, etc.; ② exogenous sugar intake too much, sometimes the early course of the disease because of misdiagnosis and the intravenous infusion of excessive glucose, or because thirsty and drink a lot of sugary drinks; ③ less than the amount of water into, such as hunger, restrictions on diet or vomiting, diarrhea, especially the elderly because of their thirst center is not sensitive to poor water intake caused by water scarcity; ④ aggravated the diabetes drugs such as corticosteroids, thiazide diuretics, propranolol; ⑤. Renal insufficiency or cardiac dysfunction caused by water and salt regulation dysfunction.

Diagnosis:

1, onset is slow, and often accompanied by disease-induced symptoms of disease or concealed, easily adversely affected by diagnosis;

2, early first polydipsia, polyuria, polyphagia not obvious or rather loss of appetite, it is often overlooked, but much higher than the urine into the water;

3, severe cell dehydration, characterized by: ① nervous system symptoms: such as irritability, drowsiness, hallucinations, convulsions, etc., finally into a coma; ② severe dehydration, there is no corresponding decrease in urine output or the performance of a multi-urine; ③ circulatory failure symptoms than the neurological symptoms were relatively light.

Laboratory examination:

Blood glucose> 33.3mmol / L, serum sodium increased up to 155mmol / L, plasma osmolality increased significantly, typically greater than 350mmol / L.

Treatment: ① rehydration: dehydration due to patients can exceed 12% of body weight, so take an active rehydration; ② insulin therapy: low-dose insulin infusion; ③ to maintain electrolyte balance: According to the potassium and the ECG added potassium; ④ positively In addition to incentives and deal with complications such as heart and kidney dysfunction.

To sum up, this syndrome is characterized by: high blood sugar, severe dehydration, blood hypertonic cause disturbance of consciousness, sometimes accompanied by epilepsy. This disease is in critical condition, more complications, mortality, hence the active prevention of paramount importance.

Preventive measures:

1, early to detect, correct and reasonable treatment of diabetes.

2, usually attention to drinking water.

3, the law of life, adequate exercise.

4, to enhance blood glucose testing.

5, early diagnosis and treatment, infection control is the key to reducing mortality.

(1) The prodromal phase. Slower onset of this disease, in the event of neurological symptoms and enter a coma before, mainly for the diabetes symptoms such as thirst, polyuria, and fatigue such as increased burnout, as well as unresponsive, indifferent expression and so on. This is mainly due to dehydration caused by osmotic diuresis. Prodromal phase for several days to several weeks. Prodromal phase if found and treated soon enough, will greatly reduce the mortality rate, but because of prodromal phase symptoms was not obvious or masked by symptoms of other complications, are often ignored by patients and doctors can easily be missed or misdiagnosed.

(2) The period of the typical symptoms. Mainly manifested in two groups of dehydration and nervous system symptoms and signs. Due to water loss were seen significantly decreased body weight, skin, mucous membranes dry, dry tongue, sunken eye sockets, blood pressure, heart rate accelerated, rather then the shock. Nervous system disorders in different groups and ketoacidosis, in addition to sensory nerve restrained and conscious indifference, even dull stupor, the motor nerve involvement are more commonly those who have stroke, varying degrees of paralysis, systemic or focal movement paroxysmal neurological manifestations, including aphasia, hemiplegia, nystagmus and strabismus, as well as focal or generalized seizures, etc., reflection often hyper-or disappear. Breathing may be accelerated due to the intense heat, but no acidosis ketoacidosis typically deep breath. If the patient appears central hyperventilation phenomenon, should consider a merger of the sepsis and cerebral vascular accident.

Diabetic hyperosmolar coma how rehydration?

Due to severe dehydration, hypertonic disease, characterized by the state-based, so the rapid rehydration, expansion, correct hypertonic to deal with the key.

(1) rehydration properties. At present, most advocates such as exudate began to lose the advantage of a large number of such effusion does not cause hemolysis, help to restore blood volume and prevent rapid decline in blood osmotic pressure leading to cerebral edema. Specific mastered according to the following conditions: ① right lower blood pressure, serum sodium less than 150mmol / L who first used such as exudate in order to restore blood volume and blood pressure, if the blood volume and osmotic pressure to restore blood pressure still decreased again when the use of low exudate. ② normal blood pressure, serum sodium greater than 150mmol / L, it can begin with the hypotonic solution. ③ If shock or systolic blood pressure consistently below 10.6kPa (80mmHg), in addition to exudate began to fill, etc., shall break lose in plasma or whole blood.

(2) infusion dose. Generally based on the patient’s body weight loss of a considerable amount of water to 10% to 12% estimate. Accurate estimate of the loss of fluid volume of patients is difficult, indeed, unnecessary.

(3) infusion rate. According to slow down after the principle of the first two hours generally lose 1000 ~ 2000mL, the first 4-hour infusion of total water loss of 1 / 3, after gradually slowing down, generally the first day of water loss can be estimated that the total supply of 1 / around 2. Particularly in elderly patients as well as coronary heart disease according to central venous infusion, not too much too fast. The transfusion of blood glucose fell to less than or equal to 13.9mmol / L, the liquid can be changed to 5% glucose solution, if it is still lower than at this time when the serum sodium can be used 5% glucose saline.

In addition, diabetic hyperosmolar coma, insulin use and potassium with diabetic ketoacidosis, but patients with diabetic hyperosmolar coma patients who required insulin compared with ketoacidosis small.

Prognosis. Diabetic hyperosmolar coma mortality rate is high or low depends largely on early diagnosis and complications of treatment, about 28% of patients in the hospital died within 48 hours after the main hypertonic. Hyperosmolar state, therefore the longer the duration of the higher mortality rate, while a variety of complications, especially infections, is the leading cause of death late. Therefore, a variety of complications from the outset, must be very great importance, particularly in the beginning of infection should be given a large dose of effective antibiotic treatment.

Preventive measures. Due to diabetic hyperosmolar coma in time even if the diagnosis, treatment, active, mortality remains high, thus actively preventing extremely important. Specific measures include the following:

① early detection and strict control of diabetes.

② prevention and treatment of various infections, stress, high fever, gastrointestinal water loss, burns and other conditions in order to avoid hyperosmolar state.

③ to avoid the use of drugs such as elevated blood glucose diuretics, corticosteroids, propranolol, pay attention to all kinds of dehydration therapy, high-nutrient flow juice, peritoneal dialysis and blood caused by dehydration.

④ on the middle-aged patients, regardless of whether there is a history of diabetes if the following conditions, it should be vigilant against the occurrence of this disease, immediately for laboratory examination (check blood glucose, potassium, sodium, chloride, urea nitrogen, urine sugar and ketone bodies, carbon dioxide combining power): a progressive disturbance of consciousness are obvious and dehydration performers; b are the central nervous system symptoms and signs, such as epileptic seizures and pathological reflex positive sign; c infection, myocardial infarction, surgery and other stress situations there is more than those in urine; d in the large intake of sugar or application of certain medications caused by elevated blood sugar, there were many changes in urine and awareness; e amount of water into the history of those who are inadequate or dehydration.

Clinically, hyperosmolar nonketotic diabetic coma in patients with mortality rates as high as 20% or so. Disease is more common in middle aged and elderly diabetic patients, male and female patients may be suffering from the disease. Some patients with the disease before the onset of illness did not know that they have diabetes. Patients with diabetes in case of hyperosmolar nonketotic diabetic coma usually occurs before the thirst, polyuria, weakness, unresponsive, indifferent expression and other symptoms. At this point, such a patient if the treatment is not reasonable, there will be continuous dry mouth and polyuria, or even dehydration symptoms, such as orbital collapse, the skin loses its elasticity, rapid heart beat, disturbance of consciousness, blood pressure drop, etc., and can be gradually into a coma.

In general, diabetes patients to the hospital the following conditions should be immediately carried out of the laboratory examination in order to prevent hyperosmolar nonketotic diabetic coma ① gradual emergence of awareness of the obstacles and the progress of dry mouth, polyuria, dry skin and other symptoms When, ② occurred when the epileptic convulsions, ③ When people with diabetes got pneumonia, influenza, cerebral vascular accident, trauma occurs when a number of diseases such as urine, dehydration symptoms, ④ intake of sugar or carbohydrates in large numbers after a number of urine changes in symptoms and consciousness; ⑤ experienced serious vomiting, diarrhea and other symptoms.

Hyperosmolar nonketotic diabetic coma prognosis good or bad, the key lies in its ability to be reasonable and timely diagnosis and treatment. For the middle-aged diabetic patients, it is necessary to keep attention to their mental state, it is necessary to do on a regular basis for blood glucose testing, not let them consume a lot of carbohydrates (including rice, flour), or sweets. Once the emergence of unconscious patients with diabetes should be promptly sent to hospital for treatment, such patients should not arbitrarily to feed syrup or intravenous hypertonic glucose, so as to prevent disease progression.

(2) careful observation of patient’s condition if it is found respiratory arrest, artificial respiration immediately.

(3) promptly call “120″ emergency phone, quickly rushed to hospital for treatment of patients.

Because diabetes is caused by coma, in addition to the reasons for low blood sugar, the blood sugar can also be caused by significantly increased hyperosmolar coma, so in a coma is not clear why it should not when fed sugar water to patients in order to avoid worse. But also to the consciousness of the patient fed sugar water will easily lead to suffocation or choking.

Into middle age, Mr. Chuang may be regarded as successful people, operates a trading company with good benefits. After many years of hard work, infighting among the business field, Gongchoujiaocuo, his body is growing in tandem with the development of hair-fu. Two years ago, a medical examination surprised to discover that hyperglycemia was really let him tense for a while, but also make a determined effort, “smoking, drinking, quit never too sweet,” good treatment. But, after all, there is no obvious physical discomfort, not to mention “The Sopranos, involuntarily,” busy with work pressure, a variety of entertainment is inevitable. “Commandments” broken several times, over time, the original tension and determination also gradually faded. Eat, drink gradually liberalized, medicine is very random, I remember eat, do not remember pulled down, blood sugar is too lazy to go test.

That evening, hosted an important customer. The customer hobbies cup thing is out of the name, of course, enjoying to the. Mr. Chong had舍命陪君子, “grind” 45 hours down, have been drinking I do not know how much Mr. Chuang feel more and more uncomfortable, the toilet on the time and time again, but also vomiting is urinating trance state of mind began to indistinct indistinct , Suddenly he fell on the ground. We thought he was drunk, and hurried him to the hospital.

Survived. Disease from hyperosmolar coma

Emergency physician immediately asked about the history quickly and concisely, and carried out a careful physical examination, found that Mr. Chuang has been in a coma, low blood pressure, skin mucous membranes dry, there is severe dehydration performance. Doctor immediately arranged a variety of inspection. Test results out soon: the blood sugar up to 45 mmol / l (normal range 3.9-6.1 mmol / l), serum sodium 150 mmol / l (normal range 135-145 mmol / l), blood osmotic pressure 370 milli-penetration Moore, l (normal value of 275 ~ 305 milli-penetration mole / l), urine ketone (++++), negative. Doctors made an initial diagnosis: non-ketotic hyperosmolar diabetic coma.

After a day of night rescue, Mr. Chuang was finally revived.

A few days later, recovering from illness, Mr. Chuang, fearful, he said to the doctor, this time finally tasted the bitterness of diabetes, “severe.” He asked the doctor: “Doctor, I am usually feeling pretty good about himself, how a sudden illness to be so serious?”

The doctor told him: “Lao-Zhuang Yeah, you remember how much that night, drinking wine? To mention you are a diabetic. You usually do not regulate the treatment, blood glucose control can imagine no better. Plus this eating and drinking, How can they not dangerous? ”

The coma, came close to being misled by drunkenness

“The coma is how come?” Asked Mr Chong.

“Unfortunately, the pathogenesis of this disease is very complex, medical scientists have until now had not completely clear. Pathogenesis of the early days, the patient is often more a result of water loss in urine, with the progression of the disease, more and more serious water loss, to the late , urine output decreased, shock, blood concentration, increased serum sodium, followed by dehydration of brain cells, showed a very prominent neuropsychiatric symptoms, such as unresponsive, drowsiness, hallucinations, tremors, epileptic seizures, even coma. “Zhuang Mr. Listen, eyes open bigger and bigger.

Doctor paused, then said: “The slow onset of the disease in general, not like you in this rapid-onset, often cover a variety of induced symptoms of the disease, it is often misdiagnosed or missed diagnosis. If the delay in treatment of this disease, heart decline, renal failure, cerebral edema and other complications a lot of very high mortality rate, so special emphasis on early detection and early treatment. like you this, if only be treated as drunk, the consequences would be unthinkable of. Fortunately, we consider that you have diabetes patients, time to do the inspection, diagnosis, correct treatment to be effective. ”

Eat a cutting wisdom. Stabilize the blood sugar is the key.

Mr. Chuang seems to have realized and asked: “That’s usually how I prevent it?” “To say is also simple, is to seriously control of diabetes. In particular, some specific symptoms in the body, the vigilance can prevent this disease place.’s right, it is to remember, every time to see the doctor, they must put their own history of diabetes, tell your doctor.

“Laozi and Zhuangzi, talked so much, after all, to change the concept of the most important. First of all to recognize the dangers diabetes, once again, we should establish the confidence and determination to overcome diabetes. Diet, exercise, monitoring blood sugar, insist on rational drug use. You want to think, win business, lost his health, and greed of the moment’s convenience and pleasure, costing him a lifetime of health, worth it? ”

“This disaster die, met with ‘ghost’ of course, fear of ‘black’ about her.” Lamented Mr. Chuang

Said, “From now on, I want to be a ‘behave’ in people.”

Hyperosmolar coma, seizures be tracked

Middle-aged patients with diabetes, if the following conditions, it should be alert on the disease from occurring, immediately to the hospital related to Inspection: ① disturbance of consciousness and apparent increased sexual performance, such as dehydration, dry mouth, dry eyes no tears; ② there central nervous system symptoms and signs such as epileptic seizures in; 3 of infection, myocardial infarction, surgery, and so has happened with more than stress urine; 4 in a large number of intake of sugar or application of certain medications caused by elevated blood sugar, there polyuria and consciousness change.

(2) preventive measures. Due to diabetic hyperosmolar coma in time even if the diagnosis, treatment, active, mortality remains high, thus actively preventing extremely important. Specific measures include the following:

① early detection and strict control of diabetes.

② prevention and treatment of various infections, stress, high fever, gastrointestinal water loss, burns and other conditions in order to avoid hyperosmolar state.

③ to avoid the use of drugs such as elevated blood glucose diuretics, corticosteroids, propranolol, pay attention to all kinds of dehydration therapy, high-nutrient flow juice, peritoneal dialysis and blood caused by dehydration.

④ on the middle-aged patients, regardless of whether there is a history of diabetes if the following conditions, it should be vigilant against the occurrence of this disease, immediately for laboratory examination (check blood glucose, potassium, sodium, chloride, urea nitrogen, urine sugar and ketone bodies, CO-binding capacity):

there is a progressive disturbance of consciousness and obvious dehydration performance of persons;

b are the central nervous system symptoms and signs, such as epileptic seizures and pathological reflex positive sign;

c In the infection, myocardial infarction, surgery and other cases, there is more than stress urinary persons;

d in the large intake of sugar or application of certain medications caused by elevated blood sugar, there were many changes in urine and awareness;

e amount of water into the history of those who are inadequate or dehydration.

Common predisposing factors are: infection, gastrointestinal diseases, acute pancreatitis, acute myocardial infarction, cerebrovascular accident, renal dysfunction and gastrointestinal disorders such as vomiting, diarrhea, dehydration does not increase the consumption of water and the hypertonic state, excessive or inappropriate intake of sugar to complement glucose. Blood sugar levels and dehydration caused by taking drugs, such as thiazide diuretics, propranolol, glucocorticoids, phenytoin sodium and other solid, or due to peritoneal dialysis, hemodialysis and dehydration.

This disease is particularly prevalent in the 60 years of age or older. About 2 / 3 patients with no clear history of diabetes, history of diabetes also mostly as a mild type Ⅱ diabetes mellitus and a small number of type Ⅰ diabetes mellitus. Hide and slow onset of this disease, early symptoms of diabetes often see the original, such as polydipsia, polydipsia, polyuria, fatigue and so increase, accompanied by loss of appetite, nausea, vomiting and abdominal pain. 1 ~ 2 days after the patient presented expressions retardation, lethargy, 1 ~ 2 weeks after gradually into a coma. Patients with neurological symptoms often outstanding performance, there may be drowsiness, hallucinations, irritability, disorientation, epileptic seizures, mental disorders, gradually entering a coma. The main signs of dehydration as a serious sign, such as dry skin, and elasticity of lower lip and tongue, dry, sunken eyes, rapid shallow breathing, heart rate increased quickly, hypotension or shock, limb Jueleng, peripheral fat Shao, high fever, as well as the severity of hemiplegia, aphasia and positive Babinski sign and other signs of the nervous system. Extremely elevated blood glucose, often greater than 33.3 mmol / l (600 mg / dl), and even up to 83.3 ~ 266.5 mmol / l (1500 ~ 4800 mg / dl), serum sodium often greater than 145 mmol / l, sometimes up to 180 mmol / l, but sometimes it can be normal or low. Plasma osmotic pressure often is greater than 350 cents infiltrators / l, sometimes up to 450 cents infiltrators / l or more. If Hydrochlorothiazide, phenytoin sodium, glucocorticoids, propranolol, or for peritoneal dialysis, hemodialysis Erzhi dehydration, to prevent the misuse of intravenous infusion of glucose solution and taking the fresh orange juice too much Erzhi hyperglycemia.

When the event of unexplained coma, severely dehydrated patients, we must think about the possibility of this disease. If diabetes occurs lethargy, apathy consciousness and other symptoms should be promptly sent to emergency or hospital treatment.