Mr. Zhang (pseudonym) is 68 years old this year. He is usually in good health. He rarely goes to the hospital. He buys vegetables with his wife every morning, goes home and has grandchildren. He lives very freely. In the past month, I did not leave my hands with tea. The number of wake-ups in the evening has increased significantly and people have lost weight. But thinking about summer is approaching, it is not very troublesome to wake up more frequently, and it has not attracted attention. One morning, Mr. Zhang had diarrhea after eating fruit. Afterwards, he felt tired and sleepy, so he lay down and went to sleep. At noon, his wife asked him to get up for dinner, and he had no appetite. In the evening, Mr. Zhang started talking nonsense, and his wife was frightened. I dialed 120 and was taken to the emergency department of the hospital.
After a series of inspections, the blood glucose meter burst and the data could not be displayed. Electrolytes: sodium 167mmol/L, chlorine 125mmol/L, blood glucose 73mmol/L, and osmotic pressure 407mmol/L. Physical examination showed: blood pressure 90/30mmHg, rapid pulse, shortness of breath, and signs of dehydration such as sunken eyeballs and skin shrinkage were found. The final diagnosis was “diabetic hypertonic coma” and he was admitted to the Endocrinology Department for further treatment.
The family members felt very puzzled: Mr. Zhang is usually healthy, but he got diabetes when he had a diarrhea, and it was so serious that he was in a coma and almost died? The doctor told him: “Diabetic hyperosmolar coma is more common in patients who don’t know that they have diabetes. It is precisely because they don’t know that they have diabetes, dehydration after diarrhea, resulting in a sharp increase in blood sugar, leading to coma.”
What is diabetic hyperosmolar coma
Diabetic hyperosmolar coma, that is, diabetic nonketotic hyperosmolar coma, is one of the serious acute complications of diabetes. It is due to the body’s stress that leads to relatively insufficient insulin in the body, and insulin counter-regulatory hormones (such as glucagon) are not Appropriate increase in secretion and increased glycogen release leads to severe hyperglycemia, which in turn leads to a clinical syndrome of high and severe dehydration, no obvious ketosis, and progressive disorder of consciousness.
What are the symptoms of diabetic hyperosmolar coma
● prodromal stage
diabetic hyperosmolar coma onset is slow and difficult to detect, in neurological symptoms appear and enter a period of time before the coma called prodromal period, the time from days to weeks range, often manifested as aggravate symptoms of diabetes, was Thirst, polydipsia, polyuria, fatigue, loss of appetite, nausea, vomiting, abdominal pain, unresponsiveness, and apathy, but many elderly patients may not have polydipsia or polyuria.
● typical of the
prodromal period left untreated, the disease continues to develop, due to severe hypertonic dehydration causes a decrease in blood plasma and blood volume, mainly in patients with severe dehydration and nervous system abnormalities.
Severe dehydration: manifested as significant weight loss, dry skin, poor elasticity, sunken eyeballs, dry lips and tongue, fast pulse, low blood pressure and even cold limbs, cyanosis and shock. At the same time, due to severe dehydration and oliguria.
Nervous system abnormalities: manifested as varying degrees of consciousness disorder, slow response, indifferent expression, hallucinations, aphasia, confusion, lethargy, coma and other symptoms (but not all patients have coma). It is often accompanied by symptoms of central nervous system damage such as localized convulsions, hemiplegia, hemianopia, and aphasia, and is often clinically misdiagnosed as “acute stroke”.
If the diagnosis and treatment are not timely, the condition will worsen, and a series of serious complications may occur, such as vascular embolism, heart failure, kidney failure, respiratory failure, gastrointestinal bleeding caused by stress ulcer, diffuse intravascular coagulation, cerebral edema, Cerebrovascular accidents, severe arrhythmia, shock, etc., these manifestations of multiple organ failure, mostly occur in coma patients.
What conditions are prone to diabetic hyperosmolar coma
The disease is more common in the elderly, the average age of onset is over 60 years old, and it occurs frequently in summer. About half of the patients have no history of diabetes before onset, or only have a history of mild diabetes. Common predisposing factors are:
●Stress state: acute infection, acute gastroenteritis (vomiting, diarrhea), trauma, extensive burns, surgery, acute stroke, gastrointestinal hemorrhage and other stress factors, which promote the increase of glycogen hormone secretion .
●Insufficient drinking water: It is more common in the elderly, especially in the summer, the human body sweats more, but because the elderly are not sensitive to thirst, the amount of drinking water is not enough, which easily leads to blood concentration and increased plasma osmotic pressure. In addition, patients who are unable to take care of themselves or are unconscious often suffer from insufficient drinking water.
●Excessive water loss: such as high fever, severe vomiting, diarrhea or inappropriate application of diuretics, dehydrating agents, etc.
●Too much sugar intake: The symptoms of diabetes in the elderly are often atypical. The patients mistakenly input a large amount of glucose or drink a lot of sweet drinks because they do not know that they have diabetes, resulting in a significant increase in blood sugar.
●Drug factors: such as glucocorticoids, β-receptor blockers, and some diuretics can cause blood sugar to rise. Insulin pump users are not detected in time due to insulin pump failure (such as blockage of the catheter), which can also lead to Sick.
How to prevent diabetic hyperosmolar coma
Diabetic hyperosmolar coma is more common in the elderly, with a dangerous prognosis and high mortality, which seriously threatens the life and health of the elderly. Although the disease is dangerous, it is completely preventable. The elderly should increase their vigilance and awareness of the disease at ordinary times. Regardless of whether they have a history of diabetes, they should pay attention to avoiding factors that may induce diabetic hyperosmolar coma to prevent the occurrence of diabetic hyperosmolar coma.
●Strict control of diabetes: The prevalence of diabetes in the elderly is on the rise, and increases with age. Therefore, the elderly should regularly monitor their blood sugar to detect diabetes early. Once the diagnosis is confirmed, active treatment is required to ensure that blood sugar is well controlled.
●Learning about diabetes: Patients and their families should understand the common symptoms of diabetic hyperosmolar coma, find abnormalities, and seek medical treatment in time. Common symptoms include: dry mouth, obvious polydipsia; significant weight loss, dry skin, poor elasticity, sunken eyeballs, chapped lips and tongue, fast pulse, lower blood pressure than usual; fatigue, obvious changes in consciousness (drowsiness, coma), etc.
●Ensure adequate drinking water: The elderly should drink more water to avoid dehydration and blood concentration, but try to drink less sugary drinks (except when hypoglycemia occurs).
●Prevention and treatment of other diseases: various infections, high fever, gastrointestinal dehydration (vomiting, diarrhea), extensive burns, gastrointestinal bleeding and other diseases may induce diabetic hyperosmolar coma, avoid high blood sugar stress factors and severe dehydration , To prevent inducing the disease.
●Check blood glucose at a doctor: The elderly should check their blood glucose first when they receive infusion treatment for a certain disease to see if they have diabetes, and eliminate related risks.
●Use drugs that may cause blood sugar to rise with caution: such as diuretics (furosemide, hydrochlorothiazide), glucocorticoids, β-blockers, glucagon, etc. If you must use it, pay attention to the effect of the drug on blood sugar and strengthen blood sugar monitoring.
●Appropriate exercise, maintain physical strength, and avoid fatigue: pay attention to mental balance and avoid excessive mental and emotional excitement.