Diabetic coma

From WikiMD
Jump to navigation Jump to search
Diabetic coma
Classification and external resources
ICD-10E10.0, E11.0, E12.0, E13.0, E14.0
ICD-9250.2, 250.3
MeSHTemplate:Mesh2
Wellness.png

WikiMD is a free medical encyclopedia moderated by medical professionals and is a reliable source of information on a wide range of health, weight loss and wellness related topics. Who wants to trust their health with amateurs?

Let Food Be Medicine, Medicine Be Food - Hippocrates

Diabetic coma is a reversible form of coma[1] found in people with diabetes mellitus. It is a medical emergency.

Three different types of diabetic coma are identified:

  1. Severe diabetic hypoglycemia
  2. Diabetic ketoacidosis advanced enough to result in unconsciousness from a combination of severe hyperglycemia, dehydration and shock, and exhaustion
  3. Hyperosmolar nonketotic coma in which extreme hyperglycemia and dehydration alone are sufficient to cause unconsciousness.

In most medical contexts, the term diabetic coma refers to the diagnostical dilemma posed when a physician is confronted with an unconscious patient about whom nothing is known except that he has diabetes. An example might be a physician working in an emergency department who receives an unconscious patient wearing a medical identification tag saying DIABETIC. Paramedics may be called to rescue an unconscious person by friends who identify him as diabetic. Brief descriptions of the three major conditions are followed by a discussion of the diagnostic process used to distinguish among them, as well as a few other conditions which must be considered.

An estimated 2 to 15 percent of diabetics will suffer from at least one episode of diabetic coma in their lifetimes as a result of severe hypoglycemia.

Types

Severe hypoglycemia

People with type 1 diabetes mellitus who must take insulin in full replacement doses are most vulnerable to episodes of hypoglycemia. It is usually mild enough to reverse by eating or drinking carbohydrates, but blood glucose occasionally can fall fast enough and low enough to produce unconsciousness before hypoglycemia can be recognized and reversed. Hypoglycemia can be severe enough to cause unconsciousness during sleep. Predisposing factors can include eating less than usual or prolonged exercise earlier in the day. Some people with diabetes can lose their ability to recognize the symptoms of early hypoglycemia.

Unconsciousness due to hypoglycemia can occur within 20 minutes to an hour after early symptoms and is not usually preceded by other illness or symptoms. Twitching or convulsions may occur. A person unconscious from hypoglycemia is usually pale, has a rapid heart beat, and is soaked in sweat: all signs of the adrenaline response to hypoglycemia. The individual is not usually dehydrated and breathing is normal or shallow. Their blood sugar level, measured by a glucose meter or laboratory measurement at the time of discovery, is usually low but not always severely, and in some cases may have already risen from the nadir that triggered the unconsciousness.

Unconsciousness due to hypoglycemia is treated by raising the blood glucose with intravenous glucose or injected glucagon.

Advanced diabetic ketoacidosis

Diabetic ketoacidosis (DKA), if it progresses and worsens without treatment, can eventually cause unconsciousness, from a combination of severe hyperglycemia, dehydration and shock, and exhaustion. Coma only occurs at an advanced stage, usually after 36 hours or more of worsening vomiting and hyperventilation.

In the early to middle stages of ketoacidosis, patients are typically flushed and breathing rapidly and deeply, but visible dehydration, pallor from diminished perfusion, shallower breathing, and tachycardia are often present when coma is reached. However these features are variable and not always as described.

If the patient is known to have diabetes, the diagnosis of DKA is usually suspected from the appearance and a history of 1–2 days of vomiting. The diagnosis is confirmed when the usual blood chemistries in the emergency department reveal hyperglycemia and severe metabolic acidosis.

Treatment of DKA consists of isotonic fluids to rapidly stabilize the circulation, continued intravenous saline with potassium and other electrolytes to replace deficits, insulin to reverse the ketoacidosis, and careful monitoring for complications.

Nonketotic hyperosmolar coma

Nonketotic hyperosmolar coma usually develops more insidiously than DKA because the principal symptom is lethargy progressing to obtundation, rather than vomiting and an obvious illness. Extreme hyperglycemia is accompanied by dehydration due to inadequate fluid intake. Coma from NKHC occurs most often in patients who develop type 2 or steroid diabetes and have an impaired ability to recognize thirst and drink. It is classically a nursing home condition but can occur in all ages.

The diagnosis is usually discovered when a chemistry screen performed because of obtundation reveals extreme hyperglycemia (often above 1800 mg/dl (100 mM)) and dehydration. The treatment consists of insulin and gradual rehydration with intravenous fluids.

Identifying the cause

Diabetic coma was a more significant diagnostic problem before the late 1970s, when glucose meters and rapid blood chemistry analyzers became universally available in hospitals. In modern medical practice, it rarely takes more than a few questions, a quick look, and a glucose meter to determine the cause of unconsciousness in a patient with diabetes. Laboratory confirmation can usually be obtained in half an hour or less. Other conditions that can cause unconsciousness in a person with diabetes are stroke, uremic encephalopathy, alcohol, drug overdose, head injury, or seizure.

Fortunately, most episodes of diabetic hypoglycemia, DKA, and extreme hyperosmolarity do not reach unconsciousness before a family member or caretaker seeks medical help.

Treatment

Treatment depends upon the underlying cause:

  • Hyperosmolar diabetic coma: plenty of intravenous fluids, insulin, potassium and sodium given as soon as possible.
  • Hypoglycaemic diabetic coma: administration of the hormone glucagon to reverse the effects of insulin, or glucose given intravenously.

References

Wikipedia

Support our sponsors

W8MD weight loss, sleep and medspa centers sponsors WikiMD.

W8MD's Locations for losing weight, sleeping better and looking your best

Philadelphia

weight loss Philadelphia | Sleep center Philadelphia

King of Prussia

Lose weight King of Prussia | Sleep doctor King of Prussia

New York

Weight loss NYC | Fast weight loss NYC | Lose weight NYC | Sleep apnea NYC

New Jersey

New Jersey Weight Loss, Sleep and Medical Spa Cherry Hill NJ

Other W8MD blogs

Lorcaserin weight loss | Qsymia weight loss | Phentermine weight loss | Weight loss blog | Free weight loss | Saxenda weight loss | Contrave weight loss

W8mdlogo.png
Tired of being overweight? W8MD can help


W8MD Weight Loss, Sleep & Aesthetic Services

Pennsylvania

Call 215-676-2334

New York

2632 E 21st Street Ste L2 Brooklyn New York 11235.

W8MD weight loss now in Manhattan, New York City

Call 718-946-5500

New Jersey

  • W8MD Weight Loss, Sleep & MedSpa in Cherry Hill, NJ at 140 E. Evesham Road, Cherry Hill, NJ 08003.

Call 800-W8MD-007

W8MD weight loss | Philadelphia medical weight loss | NYC medical weight loss


W8MD's insurance weight loss program

W8MD can help?

W8md-short.jpg

W8MD’s insurance medical weight loss program is one of the best ways to lose weight fast in NYC, King Of Prussia, Philadelphia, New Jersey and other places.

  • Our weight loss program is based on clinically proven measures to help you lose weight.
  • Our experienced weight loss doctors understand the complex causes of weight gain.
  • We use the best tools to help burn fat fast and effectively unlike many fad diets that make you lose weight by losing muscle.
  • We offer delicious, low cost and affordable weight loss supplements or meal replacements to help reduce caloric intake and burn fat.
  • We offer FDA approved weight loss medications or diet pills to help control hunger, reduce cravings and burn unhealthy fat.

Prab R. Tumpati, MD Founder, WikiMD & W8MD

Dr Tumpati is a board certified physician with significant practice experience in managing sleep disorders, internal medicine, aesthetic and obesity medicine. As one of the few physicians that have the privilege of a fellowship training in Obesity Medicine, Dr Tumpati is very passionate about educating the public and physicians about how some of the nutritional concepts were misunderstood. As the founder of W8MD Weight Loss, Sleep and MedSpa centers, Dr Tumpati is the medical director for the New York, New Jersey and Pennsylvania locations and commutes weekly between the locations.

Places for Diabetic coma

  • W8MD’s insurance weight loss programs one of the best ways to lose weight fast in NYC, King Of Prussia, Philadelphia, New Jersey and other places.

Popular weight loss searches

W8MD logo

Ad. Tired of being overweight?. W8MD's insurance weight loss can HELP*

Lose weight King of Prussia, PA | Lose weight NYC | Lose weight NJ | Lose weight Philadelphia | Advertise

Quick links: Medicine Portal | Encyclopedia‏‎‏‎ | Gray's Anatomy‏‎ | Topics‏‎ |‏‎ Diseases‏‎ | Drugs | Wellness | Obesity‏‎ | Metabolic syndrome | Weight loss*
Disclaimer: The entire contents of WIKIMD.ORG are for informational purposes only and do not render medical advice or professional services. If you have a medical emergency, you should CALL 911 immediately! Given the nature of the wiki, the information provided may not be accurate, misleading and or incorrect. Use the information on this wiki at your own risk! See full Disclaimer.
Link to this page: <a href="http://www.wikimd.org/wiki/Diabetic_coma">Diabetic coma</a>

  • Individual results may vary for weight loss from our sponsors.

Our sponsors WikiMD is supported by W8MD weight loss, sleep and medical aesthetic centers.