hyperosmolar nonketotic hyperglycemic coma
Introduction
Hyperosmotic non-ketotic hyperglycemia coma Hyperosmolar nonketotic hyperglycemia coma is a rare, severe acute diabetic complication. Its main clinical features are severe hyperglycemia, dehydration, elevated plasma osmotic pressure without significant ketoacidosis. Patients often have disturbances of consciousness or coma. The disease has a high mortality rate and should be adequately vigilant, timely diagnosis and effective treatment. basic knowledge The proportion of illness: 0.001% Susceptible people: good for the elderly Mode of infection: non-infectious Complications: dehydration shock pulmonary embolism pulmonary edema
Cause
Hyperosmotic nonketotic hyperglycemia coma
Drugs (15%):
Including a variety of glucocorticoids, diuretics, phenytoin, hibernation, propranolol, cimetidine, immunosuppressants, azathioprine and glycerol.
Stress (10%):
Such as infection (especially respiratory and urinary tract infections), trauma, surgery, cerebrovascular accident, myocardial infarction, acute pancreatitis, gastrointestinal bleeding, heat stroke or low temperature.
Insufficient water intake (40%):
Insufficient water intake is an important factor inducing.
Excessive water loss (17%):
Found in patients with severe vomiting, diarrhea, and extensive burns.
High sugar intake (8%):
High glucose intake can also cause hyperosmolar nonketotic hyperglycemia coma.
Prevention
Hyperosmotic nonketotic hyperglycemia coma prevention
Prevention is mainly to actively treat the primary disease.
Complication
Hyperosmolar nonketotic hyperglycemia coma complications Complications dehydration shock pulmonary embolism pulmonary edema
See signs and symptoms of existing diseases such as high blood pressure, heart disease, kidney disease, induced diseases such as pneumonia, urinary tract infections, pancreatitis, and concurrent diseases such as cerebral edema, vascular embolism or thrombosis.
HONK has a high mortality rate. Most of the literature reports about 50%. The case fatality rate is also reported to be 10% to 17%. Serious diseases of old age and other important organs may be important causes of high mortality. Most patients die from the original. There are diseases or diseases, the rest died of dehydration, hypovolemic shock or pulmonary embolism and other vascular embolism diseases, HONK patients died of cerebral edema during treatment, pulmonary edema and heart failure are not common, with diagnosis and treatment The level of improvement, HONK's prognosis will be greatly improved.
Symptom
Hyperosmotic non-ketotic hyperglycemia coma symptoms Common symptoms Polyuria Drinking blood pressure drop Skin dryness Dehydration consciousness disorder Appetite decline Dehydration Skin elasticity Poor dizziness
1. History: Most of the patients are elderly, half of them are known to have diabetes, 30% have heart disease, and 90% have kidney disease.
2. Prodromal symptoms: Patients from several days to several weeks before onset, often have clinical manifestations of progressively worsening diabetes, such as polydipsia, polydipsia, polyuria, fatigue, dizziness, loss of appetite and vomiting.
3. Dehydration: severe dehydration, common peripheral circulatory failure, manifested as dry skin and decreased elasticity, eyeball depression, dry tongue, pulse fast and weak, jugular vein filling is not good when lying, blood pressure drops when standing, severe shock occurs However, due to severe dehydration, there is no cold sweat during physical examination. Although some patients have severe dehydration, the hypertonicity of plasma causes the intracellular fluid to go out, supplementing the blood volume, which may mask the severity of water loss and keep blood pressure. normal.
4. Neurological manifestations: Patients often have significant neuropsychiatric symptoms and signs.
5. The performance of the original disease and induced disease.
Examine
Hyperosmolar non-ketotic hyperglycemia coma check
1. Blood sugar and urine sugar.
2. Blood ketones and ketones.
3. Electrolytes.
4. Blood urea nitrogen (BUN) and creatinine (Cr).
5. Acid-base balance: Half of the patients have metabolic acidosis.
6. Plasma osmotic pressure: significantly increased, is an important feature and diagnostic basis of HONK.
7. The main laboratory indicators for diagnosing diabetic hyperosmolar coma are:
(1) Blood sugar is greater than 33.3 mmol/L.
(2) Blood sodium is greater than 145 mmol/L.
(3) The plasma osmotic pressure is greater than 350mmol/L. If the plasma osmotic pressure cannot be determined, it can be estimated by the following formula: plasma osmotic pressure (mmol/L) = 2 (blood Na++ blood K+) (mmol/L) + blood glucose (mmol/L) + blood urea nitrogen (mmol / L) This calculated value is basically consistent with the actual osmometer measured results or about 10mmol / L, the normal range of 280 ~ 300mmol / L.
Diagnosis
Diagnosis and diagnosis of hyperosmolar nonketotic hyperglycemia coma
The diagnosis of HONK is not difficult. The key issue is to improve the understanding of this disease. For every patient with mental disorder or coma, especially for middle-aged and elderly patients, this disease should be included in the differential diagnosis, if found in the experience. Patients with significant mental disorders and severe dehydration, without significant deep breathing, should be more alert to the possibility of this disease,
Regarding the laboratory diagnosis basis of HONK, the following standards have been proposed abroad:
1 blood sugar 33mmol / L (600mg / dl);
2 effective osmotic pressure 320mmol / L;
3 arterial blood gas test showed pH 7:30 or serum [HCO3-] 15mmol / L, this standard is more practical, can be used as a laboratory diagnosis basis for our diagnosis of HONK, but it is worth noting that HONK has concurrent DKA or lactic acid The possibility of poisoning, the hyperosmotic state of individual cases is mainly caused by high blood sodium, not hyperglycemia, so urine ketone body positive, acidosis or blood glucose below 33mmol / L, can not be used as a basis for negating the diagnosis of HONK, but Patients with HONK have an obvious hyperosmotic state without exception. If the plasma osmotic pressure of a comatose patient is lower than 320 mmol/L, the possibility of other diseases that may cause coma should be considered.
