ENLmedical.com: Conditions And Concerns: Medical Encyclopedia: Diabetic Hyperglycemic Hyperosmolar coma

Diabetic Hyperglycemic Hyperosmolar coma

Causes and Risks:
Diabetic hyperglycemic hyperosmolar coma is a condition characterized by decreased consciousness , extreme dehydration , and extremely high blood-glucose levels that is not accompanied by ketoacidosis . The condition is usually seen in noninsulin-dependent diabetes mellitus and usually occurs in those previously undiagnosed, or those who have neglected their diabetes . The condition could be precipitated by an infection or by certain medications that impair glucose tolerance or increase fluid loss.

Normally the kidneys compensate for high glucose levels in the blood by excreting excess glucose in the urine. However, when dehydration occurs, the kidneys conserve fluid and glucose levels become higher, which results in greater dehydration. Hyperosmolarity is a condition in which the blood is much more concentrated with sodium, glucose, and other molecules which, in turn, attracts water into the blood stream. This creates a vicious cycle of increasing dehydration and increasing blood-glucose levels. Risk factors are older age; underlying kidney insufficiency; congestive heart failure ; recent discontinuation of insulin or oral hypoglycemic agents; and a precipitating event such as infection, stroke , or recent surgery.

Prevention:
Good control of noninsulin-dependent diabetes mellitus , recognition or early signs of dehydration and infection.

Symptoms:

Note: The onset of symptoms may be over a period of days or weeks

Additional symptoms that may be associated with this disease:

Signs and Tests:
Vital signs (temperature, pulse , rate of breathing, blood pressure ):

temperature greater than 38 degrees Centigrade (100.4 degrees Fahrenheit)
heart rate , greater than 100
systolic blood pressure , low (less than 100)

Tests:

blood glucose , severely elevated (from 600 to 2,400 milligram/deciliter)
elevated serum osmolality test
elevated serum sodium

Treatment:
The goal of treatment is to correct the dehydration which will correspondingly improve the blood pressure, low urine output, and poor circulation. Fluids and potassium are replaced by intravenous therapy. High glucose levels are treated with regular insulin, a short acting insulin preparation.

Prognosis:
The death rate associated with this condition is greater than 50%.

Complications:

acute circulatory collapse

Call Your Healthcare Provider:
This condition is a medical emergency! Go to the emergency room or call the local emergency number (such as 911) if signs or symptoms of diabetic hyperglycemic hyperosmolar coma develop.