hyperglycemic coma - is the most frequent complication, mainly diabetes, caused by lack of insulin in the body.Hyperglycemic who can be attributed to the final stage of disturbed metabolism of diabetes mellitus. Today it is observed in almost 30% of patients.
hyperglycemic coma for the first time in the form of the manifest symptoms may occur in childhood or adolescence.And death is more common among elderly people who have stock SSS disease, bronchopulmonary anomalies, infectious diseases, after injuries, as a result of surgery.
Sometimes hyperglycemic coma occurs much earlier than diabetes manage to identify yourself as a disease proceeding, as well as accession to the pathology of various infections.Furthermore, hyperglycemic coma can cause dekompensatsionnogo of diabetes after cessation of treatment with insulin or an insufficient amount in injected.
hyperglycemic coma causes
The main reason for such a state as hyperglycemic coma is a deficiency in a patient with
hyperglycemic or diabetic coma is characterized by a significant amount of sugar in the blood, but it violated the processes of its assimilation due to lack of insulin, which distinguishes it from hypoglycemic coma.
The reasons that contribute to the development of hyperglycemic coma, include the presence of inflammation in the body and viral diseases;Drinking large quantities of sweet with the introduction of the normal dose of insulin;inefficient stimulants that help the pancreas to produce insulin;Non-compliance with insulin therapy.
hyperglycemic coma has several options.Firstly, it giperketonemicheskaya acidotic coma, which is accompanied by acidosis.Secondly, it is hyperosmolar coma, which is characterized by a sharp disturbance of hydration, blood flow and the formation of the cations in the brain cells in the presence of high urine output and loss of salts.Third, it giperlaktatsidemicheskaya coma, which is formed as a result of severe infections, insufficient function of the kidneys and liver, as well as after the use of biguanide.All this provokes a breach of lactate and pyruvate system, education and the formation of a strong glycolytic metabolic acidosis and destruction of the cerebral cortex.
hyperglycemic coma symptoms
Symptomatic manifestations hyperglycemic coma associated with the poisoning of the body in the first place of the central nervous system ketones, dehydration and shift acid-base balance and to acidosis.As a rule, toxic symptoms develop gradually and hyperglycemic coma preceded prekomatosnoe state.Sometimes during the day intensified dehydration symptoms, characterized by great thirst, polyuria, decreased performance and body weight, anorexia with weakness.Later joined by manifestations of acidosis and ketosis in the form of irritability, abdominal pain, vomiting, diarrhea and sometimes disappearance of appetite and disturbed consciousness in varying degrees of severity.
On physical examination, observed all the signs of dehydration and hypovolemia.It is characterized by dryness of the skin and mucous membranes, reduced turgor eyeballs and skin, hypotension, tachycardia.In addition, in patients with hyperglycemic coma marked decrease in muscle tone, during exhalation of air patients can feel the smell of acetone or the smell of rotting apples.Against the background of pronounced acidosis Kussmaul breathing is heard as part of a deep and noisy.
Almost half of patients with hyperglycemic coma has all the symptoms psevdoperitonita: intense and painful abdominal wall, abdominal pain, decreased peristalsis.During the abdominal examination is sometimes diagnosed acute gastroparesis as a result of such a feature as hypokalemia.Symptomatology false acute abdominal shape is formed by the action of ketone bodies on the gastric and intestinal tract, and as a consequence of the dehydration of the peritoneum.
Use this hyperglycemic coma as hypokalemia develops after initiation of treatment.Thus in patients with impaired heart rate, muscle cramps occur and paresis of peristalsis.Moreover, there is undulating with a possible change in its temperature increase or decrease that can cause infection.
symptoms of impaired consciousness and develop gradually.Initially, there is a kind of drowsiness and stunned, then celebrated stupor and begins hyperglycemic coma, which is characterized by a reduction or loss of reflexes, later this leads to collapse and oligoanuria.In urinalysis determined a significant sugar content with the appearance of ketone bodies.
hyperglycemic coma (hyperosmolar) is a condition in which increased osmolarity of blood glucose by increasing the dehydration and gipovalemiey.This hyperglycemic coma, ketoacidosis caused not, as the presence of extracellular hyperosmolarity character, which develops as a consequence of dehydration at the cellular level, and hyperglycemia.In children, it almost does not occur.
As a rule, on the development of hyperglycemic coma (hyperosmolar) is influenced by a significant consumption of food rich in carbohydrates;various circulatory disorders, such as coronary and cerebral;surgery;infection;trauma;Dehydration and others. Such hyperglycemic coma may develop within two weeks.
Symptoms hyperglycemic coma (hyperosmolar) is characterized by gradual onset and may further cause hypovolemic shock.Patients determined by dry skin, reduced its turgor, rapid breathing, high blood pressure and temperature, the eyeballs are soft, tone muscles tense, epileptiform convulsions, oliguria, hemiparesis with pathological Babinski sign and symptoms of meningeal etiology.Not determined acetone smell is observed symptom Kussmaul.
Furthermore, for this kind of hyperglycemic coma characterized by high dehydration, osmolarity and blood glucose.The symptoms of thirst, polyuria and polydipsia are also characterized by this type of hyperglycemic coma.But oliguria with azotemia develop much faster in the past, unlike ketoacidosis.In the future, the child becomes adynamic, drowsiness, hallucinations appear.At the time of hospitalization in some patients have fever and shock.
In addition, early symptoms of profound neuropsychiatric disorders, which may lead to incorrect diagnosis.All these neurological symptoms in the form of seizures, meningism, pathological reflexes can change quickly in the space of a few hours.
hyperglycemic coma (laktatatsidemicheskaya) typical for elderly patients who have concomitant diseases of the lungs, kidneys, liver, heart and chronic alcoholism.
There are several types hyperglycemic coma (laktatatsidemicheskoy), namely a first type develops due to tissue hypoxia.For the second characteristic pathology of organs and systems.The third type affect the drugs or toxins.In the formation of the fourth type hyperglycemic coma participate disorders at the genetic level.
Signs hyperglycemic coma associated with the appearance in the body tissues of the patient lactic acid.Typically, the symptoms are progressing S.S.N.
hyperglycemic coma begins quite sharply with the emergence delirium, dyspeptic phenomena of nature, pain in the heart, resembling angina.Also marked muscle pain and stomach, simulating surgical pathology.Then, with growing difficulty breathing symptom Kussmaul, there is a collapse, hypothermia and oliguria.Decreases turgor skin with the appearance of marble and cyanotic shade.This skin is cold to the touch, eyeballs are soft and can not be determined acetonuria.Blood glucose minor amount, about 15 mmol / l.Typically, this form of hyperglycemic coma has a poor prognosis, because it is difficult to diagnose, and therefore prescribe adequate treatment is also problematic.
hyperglycemic coma in children
In childhood, hyperglycemic coma caused by a slow rise in blood glucose to near 13 mmol / L.
etiological factor in the development hyperglycemic coma is generally considered diabetes, and even late late diagnosis and treatment of disease.According to some experts, in the formation of this disease have been violations in the regulation of neuro-hormonal nature.Other sources claim that the reasons for the development of hyperglycemic coma in children can be: wrong destination insulin that is assigned to the wrong dose, or a substitution of another kind, to which the child has no sensitivity;eating disorders;intercurrent acute forms of diseases, especially with regard to the purulent infection;Pathology S.S.S .;surgery;shocks nervous character;used in high doses of corticosteroids.Thus, these factors contribute to the body's need for insulin, and this becomes a cause of a severe form as islet failure, and metabolic syndrome.
On the mechanism of hyperglycemic coma in children is ketoatsidoticheskaya hyperglycemic, hyperosmolar hyperglycemic without ketoacidosis and laktatatsidemicheskoy.
for hyperglycemic coma ketoatsidoticheskaya character, which is the most common complication of diabetes, is characterized by severe insulin deficiency, occurs when inadequate treatment of the underlying disease or increased insulin requirements as a result of infection, injury, surgery, stress and others. Nearly one-third of cases of this form of developingin children as a result of unrecognized diabetes.
hyperglycemic coma (ketoatsidoticheskaya) develops very slowly, over several days.If not enough insulin in the body of a child violated the processes of glucose utilization.This causes hyperglycemia and glucosuria, which promotes the formation of ketosis.
Symptomatic are three successive stages hyperglycemic coma: moderate ketoacidosis, prekomatosnoe state and coma.
Sick children with moderate ketoacidosis experience symptoms of general weakness, they are sluggish, tired quickly, constantly want to sleep.Some complained of the emergence of tinnitus, their sick, and they always want to drink, but the appetite is greatly reduced.Sometimes these children experience abdominal pain and pretty frequent urination.From these patients, there is a smell of acetone in conversation.The urine is observed moderate glyukozoriya and ketone bodies.In the blood - hyperglycemia, ketonemia and a slight decrease in pH.
In the absence of appropriate treatment, moderate ketoacidosis becomes hyperglycemic Preko.Thus, the patient begins to feel sick child with frequent bouts of vomiting.He is absolutely indifferent to everything around him.Then abdominal pain amplified and pain in the heart.The child also thirsty, urinating often, and thus remains in the mind, but his reaction a little inhibited.The questions can respond in monosyllables and indistinctly.The skin is dry, rough and cold to the touch.On the lips, cyanotic color, cracks and peels, and the language is crimson and dirty-brown plaque with prints on the edges of the teeth.All tendon reflexes weakened, and hyperglycemia is almost 25 mmol / L.Precoma This condition can last several hours and several days.But without taking remedial measures comes the stage of coma.
This stage is characterized by loss of consciousness, a decrease in temperature, dryness and sagging skin, muscle hypotonia, low tone of the eye, the disappearance of the reflexes.At the same time the child begins deep and noisy breathing quickened.There elongated breath and short breath with a sharp odor of acetone or Mochenov apples.This scent will be present in the room sick child.Furthermore, frequent detectable, small filling pulse, reduced blood pressure, diastolic particularly, which can lead to collapse.In this situation, with palpation of the abdomen tense, a little drawn and practically does not participate in breathing.Laboratory diagnosis detects hyperglycemia nearly 50 mmol / L, glucosuria and acetonuria.The highly elevated blood ketone bodies, creatine, urea, and sodium, conversely, lowered.Also revealed leukocytosis with neutrophilic shift.
hyperglycemic coma may contribute to the emergence of a lack of kidney function, so reduced or completely stopped ketonuria and glycosuria.
hyperglycemic coma (ketoatsidoticheskaya) by AAMartynov has four kinds of steps precoma as abdominal, cardiac, renal, and encephalopathy.
Clinic abdominal form is characterized by the dominance of dyspeptic phenomena of nature, abdominal pain and tense muscles in the front of the peritoneum.Sometimes there is vomiting, the color of coffee grounds, there is intestinal, all that imitates "acute abdomen."
to form cardiac symptoms characterized by vascular collapse and heart failure in the form of cyanosis, tachycardia, inspiratory dyspnoea, cardiac arrhythmias.
prekomatosnoe condition of kidney-shaped diagnosed in children diagnosed with diabetic nephropathy, which is manifested dysuria.In rare cases acute renal failure and anuria.
form encephalopathy among the most severe in the hyperglycemic coma (ketoatsidoticheskaya), which is characterized by symptoms associated with acute blood circulation in the brain.
hyperglycemic coma treatment
At the beginning of the treatment of hyperglycemic coma, one of the most important events is the therapy with high doses of regular insulin and the introduction of the required amount of solution of NaCl and 2.5% solution of sodium bicarbonate.
The first patient in a state precoma or hyperglycemic coma need to deliver an urgent basis to the Department of IT (intensive care).
the basis of the principles of treatment are actions such as holding of cellular rehydration and other spaces;implementation of substitution therapy introduction of single-acting insulin;normalization of the main indicators of acid-base balance and electrolyte levels;Warning iatrogenic hypoglycemia.And if you have an infectious disease of viral etiology and necessary to carry out the appropriate treatment, to identify and treat other pathologies that have contributed to the development of hyperglycemic coma, and then assign the symptomatic treatment.
Tactical treatments hyperglycemic coma can be divided into two fragments.First - this is insulin, and secondly - it's infusion therapy.Generally, three modes of insulin used for the treatment of hyperglycemic coma.The first mode is characterized by continuous intravenous administration of small doses of insulin.The second mode is peculiar method, which is usually used insulin in small amounts.The third mode - a method which introduces significant dose of the drug, using the fractional introduction.
The first mode-machines used syringes for intravenous infusion of insulin.Today, this method is widely recognized throughout the world and its essence is this: the quantitative content of glucose to 33.3 mmol / l begin therapy with continuous intravenous insulin administration, where his speed is 6-10 units per hour, and for large values