Non-ketotic hyperosmolar coma
Posted on October 21, 2009
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Non-ketotic hyperosmolar diabetic coma, is a severe dehydration, high blood glucose, high plasma osmotic pressure and varying degrees of neuropsychiatric symptoms as the main clinical manifestations, without obvious ketoacidosis, often accompanied by low blood pressure, cerebral vascular accidents, renal insufficiency and so on. Mortality rate as high as 40% to 70%, the importance of early diagnosis and treatment.
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.
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