Hyperosmolar coma – causes, symptoms & therapy

Hyperosmolares Koma

Hyperosmolar coma is associated with diabetes . Infections and certain medications can promote the development of hyperosmolar coma. The course can be serious and it can be fatal in about ten to twenty percent of cases, depending on the severity.

What is a hyperosmolar coma?

Hyperosmolar coma can occur in type 2 diabetics . It is triggered by a lack of insulin. The lack of insulin can be caused by severe infections, poorly controlled blood sugar, undiagnosed diabetes or missing a few doses of insulin (especially in the elderly). It is a diabetic coma , whereby a distinction is made between ketoacidotic and hyperosmolar coma.

In the hyperosmolar coma, only dramatically increased blood sugar levels play a role, which leads to a derailment of the sugar metabolism. Hyperosmolar means there are too many solids, like glucose, in very little liquid.

causes

Hyperosmolar coma often develops over a longer period of time, and blood sugar levels can become higher and higher over days because the amount of insulin in the body is too low to control the production of more and more glucose in the liver. As a result of the high blood sugar level, the sugar – the glucose – is excreted in the urine. However, since large amounts of fluid are required for this, the affected person slowly dries out and hyperosmolar coma occurs, since the body is no longer able to lower blood sugar and regulate the fluid balance accordingly after a certain persistently high blood sugar level.

Even drinking a lot alone cannot prevent hyperosmolar coma. The loss of fluid is not the only thing that thickens the blood. The brain also tries to balance the fluid balance with the cerebrospinal fluid (liquor). The brain cells release water into the cerebrospinal fluid and also excrete sodium in the process. The brain wants to compensate for this loss of sodium by absorbing potassium, but potassium cannot replace sodium and this leads to clouding of consciousness up to and including hyperosmolar coma, sometimes also associated with seizures .

symptoms and course

Typical symptoms of hyperosmolar coma:

The most common first signs and symptoms of hyperosmolar coma are impaired consciousness, such as blurred vision, tiredness, difficulty concentrating, and dizziness. In addition to these symptoms, other signs in combination with the main symptoms can indicate the approaching coma. Thrombosis , circulatory disorders, stiff neck, abdominal pain, low blood pressure and pneumonia are also among the insidious symptoms or early signs. Furthermore, the affected person can suffer from nausea or vomiting, which further burdens the fluid balance. It can be life-threatening in about ten to twenty percent of cases.

Diagnose

The hyperosmolar coma is always accompanied by very high blood sugar levels. It is not uncommon for blood sugar levels to be over 600 to 1000 milligrams per deciliter (the norm is less than 110 milligrams per deciliter in fasting blood sugar and a maximum of 160 milligrams after a meal). The first step in making a diagnosis is a blood sugar test. The sodium and potassium levels in the blood are also determined. Since an infection often promotes the development of hyperosmolar coma, the CRP inflammation value is determined and, if necessary, the source of the infection is sought.

treatment and therapy

Treatment of hyperosmolar coma is started immediately. Since the patient is unconscious, the options are limited. Before all other measures, the patient is supplied with liquid via an intravenous access, since the loss of liquid should be compensated for first. The patient is fed about five to six liters of electrolyte solution in the first eight hours. This initiation of therapy is initiated by the emergency services.

In the hospital, the patient is treated with insulin and is usually monitored in an intensive care unit. The blood values ​​are checked again and again at very short intervals and the therapy is adjusted accordingly until the blood and metabolic values ​​of the patient have normalized. If there is an infection , it will also be treated with an antibiotic . After successful therapy of the hyperosmolar coma, the patient is readjusted so that the blood sugar values ​​are in the normal range in the future. Those affected are informed about what medication they may not be able to take without further ado (e.g. diuretics) and what special features they need to be aware of in the case of a severe inflammatory disease.

prevention

Hyperosmolar coma can only be partially prevented. As a rule, there is not much that can be done against a severe infection, which sometimes goes unnoticed by those affected, apart from the normal preventive measures against such infections, such as avoiding direct contact with pathogens. However, patients suffering from type 2 diabetes have the opportunity to pay attention to the first symptoms and to interpret disturbances of consciousness as well as more frequent urination and dry mouth as well as tiredness as signs of very high blood sugar and to check the blood sugar levels before the onset of a comatose state.

In the case of unusually high values ​​​​despite regular intake of diabetes medication, the person concerned should no longer participate in road traffic, but immediately call the emergency services. If insulin is forgotten, it should be made up for immediately.

Dorothy Farrar

Hello and welcome to my Health Guide & Encyclopedia! My name is Dorothy Farrar, and I'm the founder and main author of this platform.
My passion for health and wellness started at a young age when I became interested in the connection between the food we eat and the way we feel. This fascination led me to study nutrition and dietetics in college, where I learned about the importance of a balanced diet and the impact of various nutrients on the body.

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