1st order laboratory parameters – obligatory laboratory tests. Small blood count [Hk↑ due to dehydration (lack of fluid) and hyperglycemia (high blood sugar) in coma diabeticum] Inflammatory parameters – CRP (C-reactive protein) or ESR (erythrocyte sedimentation rate). Urine status (rapid test for: pH, leukocytes, nitrite, protein, glucose, ketone, urobilinogen, bilirubin, blood), sediment, if necessary urine … Diabetic Coma: Test and Diagnosis
Therapy goals Slow normalization of blood glucose (BG). Balancing the water and acid-base balance Balancing the electrolytes (blood salts) Therapy recommendations Diabetic ketoacidosis (DKA; synonym: ketoacidotic coma) is primarily corrected by insulin, fluid, and potassium administration Hyperosmolar nonketotic coma or syndrome (HNKS; synonyms: hyperosmolar diabetic coma; hyperglycemic coma) is treated by administration of saline and … Diabetic Coma: Drug Therapy
Obligatory medical device diagnostics. Electrocardiogram (ECG; recording of the electrical activity of the heart muscle). X-ray of the thorax (X-ray thorax/chest), in two planes. Optional medical device diagnostics – depending on the results of the history, physical examination and obligatory laboratory parameters – for differential diagnostic clarification. Computed tomography/magnetic resonance imaging of the skull (cranial … Diabetic Coma: Diagnostic Tests
Diabetes screening Diabetes screening using a blood test as part of newborn screening: by detecting multiple beta cell autoantibodies in the blood, type 1 diabetes can be detected at a very early, still asymptomatic stage with a sensitivity of almost 90%, thus preventing ketoacidosis. To prevent diabetic coma, attention must be paid to reducing individual … Diabetic Coma: Prevention
The following symptoms and complaints may indicate ketoacidotic coma (diabetic ketoacidosis, DKA): Symptoms of precoma Anorexia (loss of appetite). Nausea, vomiting Thirst Polydipsia (increased drinking) Polyuria (increased urination) Tendency to collapse Abdominal pain – due to pseudoperitonitis (pseudoperitonitis diabetica). Acidotic breathing (Kussmaul breathing) – very deep and slowed, regular, rhythmic breathing with acetone odor (ketone … Diabetic Coma: Symptoms, Complaints, Signs
Pathogenesis (disease development) of ketoacidotic coma In ketoacidotic coma, absolute insulin deficiency causes simultaneous hyperglycemia (hyperglycemia; glucose: > 250 and < 600 mg/dl) and lipolysis (mobilization of fat reserves), which in turn leads to hypovolemia (amount of blood in the body ↓) and metabolic acidosis (metabolic acidosis of the blood) via hyperosmolarity and ketosis. Etiology … Diabetic Coma: Causes
General measures Immediately make an emergency call! (Call number 112) Intensive medical monitoring Close monitoring of blood values – glucose, blood gas analysis, electrolytes (potassium, sodium). Review of permanent medication due topossible effect on the existing disease. Decubitus prophylaxis (preventive measures to prevent bedsores). Pneumonia prophylaxis (preventive measures to prevent pneumonia). Thromboembolism prophylaxis (preventive measures … Diabetic Coma: Therapy
A comprehensive clinical examination is the basis for selecting further diagnostic steps. In principle, an emergency physical examination must first be performed in conscious comatose individuals: Glasgow Coma Scale (GCS) – scale for estimating impaired consciousness. Criterion Score Eye opening spontaneous 4 on request 3 on pain stimulus 2 no reaction 1 Verbal communication conversational, … Diabetic Coma: Examination
Medical history (history of illness) represents an important component in the diagnosis of diabetic coma. Family history What is the general health of your family members? Are there any diseases in your family that are common? Are there any hereditary diseases in your family? Social history What is your profession? Are you exposed to harmful … Diabetic Coma: Medical History
Conditions that can lead to impaired consciousness: Respiratory system (J00-J99) Coma hypercapnium – coma caused by a marked increase in the level of carbon dioxide in the blood. Endocrine, nutritional and metabolic diseases (E00-E90). Addison’s crisis – decompensated Addison’s disease; this describes primary adrenocortical insufficiency resulting in, among other things, failure of cortisol production. Coma … Diabetic Coma: Or something else? Differential Diagnosis
The following are the major diseases or complications that may be contributed to by ketoacidotic coma: Cardiovascular system (I00-I99). Thromboembolism Infectious and parasitic diseases (A00-B99). Infections, unspecified Psyche – nervous system (F00-F99; G00-G99). Psychosis Symptoms and abnormal clinical and laboratory findings not elsewhere classified (R00-R99) Volume-deficiency shock Genitourinary system (kidneys, urinary tract – reproductive organs) … Diabetic Coma: Complications
