Treatment

Hyperosmolar coma. Hyperosmolar coma in diabetes mellitus: Medical blog of an emergency physician. Errors and unreasonable assignments

Lecture No. 8. Hyperosmolar coma

A condition in which there is increased content high osmotic compounds in the blood, such as sodium and glucose, is called hyperosmolarity. As a result of the weak diffusion of these substances into the cells, a fairly pronounced difference in oncotic pressure appears between the extra- and intracellular fluid.

As a result, intracellular dehydration first develops, which subsequently leads to general dehydration of the body. Brain cells are primarily exposed to intracellular dehydration. The greatest risk of developing hyperosmolarity occurs when diabetes mellitus Type II, more often in older people. In type I diabetes mellitus, hyperosmolar coma develops extremely rarely. Hyperosmolar coma is accompanied by a high level of glycemia, which can be 50 mmol/l or more. In hyperosmolar coma, the phenomenon of ketoacidosis is absent. Hyperosmolar coma is a more severe complication of diabetes mellitus than ketoacidotic coma.

Etiology

The development of hyperosmolar coma is provoked by dehydration and insulin deficiency. Dehydration, in turn, is provoked by conditions such as vomiting, diarrhea, acute pancreatitis or cholecystitis, blood loss, long-term use of diuretics, impaired renal function of a concentration nature, etc. A variety of injuries, surgical interventions, and long-term use of steroid drugs lead to increased insulin deficiency in diabetes mellitus.

Pathogenesis

Initially, there is an increase in the concentration of glucose in the blood. There are several causes of hyperglycemia: severe dehydration, increased glucose production in the liver, and large number glucose entering the blood exogenously. The concentration of glucose in the blood is constantly increasing.

This fact is explained by two reasons. The first reason is impaired renal function, which reduces the amount of glucose excreted in the urine.

The second reason is that excess glucose suppresses insulin secretion, resulting in it not being utilized by cells. A progressive increase in glucose concentration is toxic to the β cells of the pancreas. As a result, they completely stop producing insulin, exacerbating existing hyperglycemia. The response to dehydration is a compensatory increase in aldosterone production. This leads to hypernatremia, which, like hyperglycemia, aggravates the state of hyperosmolarity.

Initial stages hyperosmolar coma is characterized by the appearance of osmotic diuresis. This, together with the hyperosmolarity of the blood plasma, causes the rapid development of hypovolemia, dehydration of the body, and a decrease in the intensity of blood flow during internal organs and increasing vascular collapse.

General dehydration of the body is accompanied by dehydration of brain neurons, severe microcirculation disorders, which is main reason disturbances of consciousness and the appearance of other neurological symptoms. Dehydration leads to increased blood viscosity. This, in turn, causes an excess amount of tissue thromboplastin to enter the bloodstream, ultimately leading to the development of DIC.

The development of symptoms of hyperosmolar coma occurs slowly - several days or weeks. Initially, there is an increase in signs of decompensation of diabetes mellitus, such as thirst, weight loss and polyuria. At the same time, muscle twitching appears, which constantly intensifies and turns into convulsions of a local or generalized nature. Impaired consciousness can be observed already in the first days of the disease. First, these disturbances manifest themselves as a decrease in orientation in the surrounding space. Constantly progressing, disturbances of consciousness can develop into a state of coma, which is preceded by the appearance of hallucinations and delirium.

Hyperosmolar coma is characterized by the fact that its neurological symptoms are polymorphic and are manifested by convulsions, paresis and paralysis, speech disorders, the appearance of nystagmus, and pathological meningeal symptoms. Typically, the combination of these symptoms is considered an acute cerebrovascular accident.

Upon examination, symptoms of severe dehydration are revealed: dryness skin and visible mucous membranes, skin turgor, muscle tone and tone eyeballs reduced, pointed facial features are noted. Breathing becomes shallow and frequent.

There is no smell of acetone in the exhaled air. There is a decrease blood pressure, rapid pulse. Quite often the body temperature rises to high numbers. Usually the final stage is the development of hypovolemic shock, which is caused by pronounced circulatory disorders.

Laboratory and instrumental diagnostic methods

When examining blood, an increase in the amount of glucose to 50 mmol/l and above, hypernatremia, hyperchloremia, hyperazotemia, polyglobulia, erythrocytosis, leukocytosis and an increase in hematocrit are noted. Characteristic distinctive feature is an increase in plasma osmolarity, which is normally 285–295 mOsmol/L.

Compared to ketoacidotic coma, hyperosmolar coma therapy has its own characteristics. In this case, therapy is aimed at eliminating dehydration in the body, combating hypovolemic shock, as well as normalizing acid-base levels. In case of development of hyperosmolar coma, patients are hospitalized in the intensive care unit. At the prehospital stage of treatment, gastric lavage and insertion of a urinary catheter are performed. A necessary measure is the establishment of oxygen therapy. The following procedures are carried out in the intensive care unit: laboratory tests: determination of the level of glycemia, potassium, sodium, urea, lactate, ketone bodies, serum creatinine, acid-base status and effective plasma osmolarity.

Rehydration therapy for hyperosmolar coma is carried out to a greater extent than for ketoacidotic coma. The amount of intravenously administered fluid reaches 6–10 liters per day. In the first hour of this type of therapy, 1–1.5 liters of fluid are administered intravenously, in the second and third hours 0.5–1 liters are administered, in subsequent hours – 300–500 ml.

The choice of solution for intravenous administration depends on the sodium content in the blood. If the serum sodium level is more than 165 mEq/L, then the administration of saline solutions is contraindicated. In this case, rehydration therapy begins with the administration of a 2% glucose solution.

If the sodium level is 145–165 mEq/L, then rehydration therapy is carried out with a 0.45% (hypotonic) sodium chloride solution. Already during rehydration, a pronounced decrease in the level of glycemia occurs due to a decrease in its concentration in the blood.

With this type of coma, there is a high sensitivity to insulin, so its intravenous administration is carried out in minimal doses, which are about 2 units of insulin short acting per hour

If the glycemic level decreases by more than 5.5 mmol/l, and plasma osmolarity decreases by more than 10 mOsmol/l per hour, pulmonary and cerebral edema may develop. If the sodium level decreases 4–5 hours after the start of rehydration therapy while a pronounced level of hyperglycemia persists, hourly intravenous insulin administration is necessary in a dose of 6–8 units. When the glycemic level reaches below 13.5 mmol/l, the insulin dose is halved and averages 3-5 units/hour.

Indications for transferring to subcutaneous insulin administration are maintaining glycemia at a level of 11–13 mmol/l, the absence of acidosis of any etiology and eliminating dehydration of the body. The dose of insulin in this case is the same and is administered at intervals of 2–3 hours, which depends on the level of glycemia. Restoration of potassium deficiency in the blood can begin immediately after its detection or 2 hours after the start of infusion therapy.

Potassium deficiency begins to be restored immediately after its detection if renal function is preserved. The amount of potassium administered intravenously depends on its level in the blood. If the amount of potassium is less than 3 mmol/l, then 3 g of potassium chloride is injected intravenously every hour, if the potassium content is 3–4 mmol/l – 2 g of potassium chloride, 4–5 mmol/l – 1 g of potassium chloride. When the potassium level reaches 5 mmol/l or more, the administration of potassium chloride solution is stopped.

In addition to these measures, it is necessary to fight the collapse, carry out antibacterial therapy. In order to prevent thrombus formation, heparin is administered intravenously at a dose of 5000 units 2 times a day under the mandatory control of the hemostatic system.

Hyperosmolar coma is a special type diabetic coma, which is no less than five and no more than 10% of the total number of hyperglycemic comas. The mortality rate in the presented case reaches approximately 30-50%. The presented form of coma is formed, as a rule, in elderly people with type 2 diabetes mellitus due to dehydration. The use of diuretics, steroids and pathology of the cerebral vessels, as well as the kidneys, can also have a decisive influence on this. According to statistical data, in almost 50% of patients who developed hyperosmolar coma, diabetes mellitus had not previously been identified.

Clinical picture

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Reasons for the development of the condition

The leading factor in the development of hyperosmolar coma in a diabetic should be considered dehydration against the background of increasing relative insulin deficiency, which leads to an increase in glycemic levels. In general, the development of the presented condition will be influenced by the addition of intercurrent (accidentally added, complicating other ailments) diseases and infectious pathologies. Burns and even injuries, progressive destabilization of the cerebral and coronary circulation may also have an impact on this. Another significant development factor should be considered gastroenteritis and pancreatitis, which are traditionally associated with vomiting and diarrhea.

The formation of the presented syndrome will be facilitated by blood loss of various origins, for example, due to surgical intervention. In some cases, the presented type of diabetic coma is formed due to:

  • therapy with diuretics, glucocorticoids, immunosuppressants;
  • introduction of significant volumes of saline, hypertonic solutions, as well as mannitol;
  • implementation of hemodialysis and peritoneal dialysis.

The situation will be aggravated by the use of glucose and excess use of carbohydrates.

Talking about what hyperosmolar coma is, one cannot ignore its main symptoms.

Symptoms of coma development

The comatose state develops gradually. In the medical history of the vast majority of patients, the course of diabetes immediately before coma was mild and optimally compensated. For this purpose, oral hypoglycemic drugs were used, as well as dietary nutrition. A few days before the formation of coma, patients experience increasing thirst, polyuria and even weakness. The condition of a patient with diabetes mellitus will constantly worsen, and a progressive development of a condition such as dehydration is noted. Certain disturbances within consciousness appear, for example, the addition of drowsiness or lethargy, which gradually turns into a coma.

It is noteworthy that neurological and neuropsychiatric conditions are characteristic. For example, we can talk about hallucinations, hemiparesis, slurred speech. In some cases, a coma may be accompanied by convulsions, areflexia, and increased muscle tone. Another likely symptom is the appearance of high temperature, which will be held for a long time. Of course, given the criticality of such a condition as hyperosmolar coma, it must be subjected to correct and complete diagnosis in order to subsequently begin a recovery course.

Diagnostic measures

Diagnosis is most often complicated by the fact that it must be carried out extremely quickly in order to begin treatment for a diabetic as soon as possible. That is why factors such as the addition of sinus tachycardia and arterial hypotension. Please note that:

  • in a certain proportion of patients, local edema due to venous thrombosis is identified, therefore a determination of blood hyperosmolarity is required;
  • Characteristic is obvious hyperglycemia, decreased diuresis, even reaching anuria, severe glucosuria without the addition of ketonuria.
  • differentiation from a diabetic ketonemic coma is based on the absence of signs of ketoacidosis in diabetic non-ketonemic gynerosmolar coma.

Also, one should not forget about severe dehydration, increased rates hyperglycemia. A very high level of glycemia and osmolarity is identified in the blood, but ketone bodies are not identified.

Treatment for development of coma

When providing such support to a patient, it is strongly recommended to address dehydration and hypovolemia. Restoration of optimal plasma osmolarity may also be necessary. Infusion procedures, if hyperosmolar coma has been identified, are carried out in a specific order

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Speaking of this, it is strongly recommended to pay attention to the fact that during the first hours from the moment of hospitalization, the patient will need intravenous administration of two to three liters of a 0.45% composition based on sodium chloride. A more precise amount should be determined exclusively by a specialist, depending on the specific health conditions. After this, you will need to switch to an infusion of an isotonic solution. This treatment of hyperosmolar coma continues in parallel with the use of a hormonal component until glucose levels decrease to 12-14 mmol per liter.

After this, in order to avoid recurrent coma, a 5% glucose solution is administered intravenously. The next mandatory step is the administration of a hormonal component in order to utilize glucose. Speaking about the presented treatment, it should be borne in mind that it should be carried out in a proportion: four units of insulin per gram of glucose. In addition, treatment may include:

  • In order to relieve dehydration in such patients, there is often a need to use significant volumes of fluid. In some cases, the figures presented reach 20 liters within 24 hours;
  • electrolyte levels are adjusted;
  • in the vast majority of cases, coma occurs in diabetics with mild or moderate severity pathological condition, and therefore their body reacts quite normally to the use of the hormonal component.

In this regard, experts insist that very large dosages of the drug should not be used. It is advisable to administer relatively small doses, namely 10 units over 60 minutes. Of course, such indicators may change due to the recommendations of a specialist and individual characteristics condition.

Features of emergency care for diabetics

Help for a condition such as hyperosmolar coma is aimed at eliminating metabolic disorders. It will be equally important to eliminate the acidosis itself and all its symptoms, as well as to take care of qualified treatment cardiovascular pathologies. When a patient is admitted to intensive care, the first step is to perform a rapid blood glucose test every 60 minutes if glucose is being administered intravenously. If its use was carried out subcutaneously, then we will talk about once every three hours.

This is especially necessary if there is a need to identify ketone bodies in urine.

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Prevention and prognosis

There are no specific measures to prevent hyperosmolar coma. It is strongly recommended to maintain optimal sugar levels and monitor other vital criteria for a diabetic. A very important point is proper and nutritious nutrition and the elimination of bad habits.

Speaking about the prognosis for hyperosmolar coma, it is strongly recommended to pay attention to its ambiguity. The fact is that about 50% of patients die as a result of an unexpected development of the condition. That is why the prognosis can be positive only with early detection of a coma or mild and medium degree severity of pathology.

Thus, hyperosmolar coma is a severe condition, the diagnosis and treatment of which should be carried out as early as possible. It is very important to provide interventions that are associated with emergency diabetes care. It is in this case that it will be possible to talk about preserving the patient’s vital functions and the maximum degree of activity.

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Hyperosmolar coma is a complication of diabetes mellitus, which is characterized by hyperglycemia, hyperosmolarity of the blood. Expressed in dehydration (dehydration) and the absence of ketoacidosis. Observed in patients over 50 years of age who have insulin dependent type diabetes mellitus may be combined with obesity. Most often occurs in people due to bad treatment disease or lack thereof.

The clinical picture can develop over several days until complete loss of consciousness and lack of response to external stimuli.

Diagnosed by laboratory and instrumental examination methods. Treatment is aimed at reducing blood sugar levels, restoring water balance and bringing a person out of a coma. The prognosis is unfavorable: death occurs in 50% of cases.

Etiology

Hyperosmolar coma in diabetes mellitus is a fairly common phenomenon and is observed in 70–80% of patients. Hyperosmolarity is a condition that is associated with high levels of substances such as glucose and sodium in a person's blood, which leads to dehydration of the brain, after which the entire body becomes dehydrated.

The disease occurs due to the presence of a person or is the result of a violation of carbohydrate metabolism, and this causes a decrease in insulin and an increase in the concentration of glucose with ketone bodies.

The patient’s blood sugar increases for the following reasons:

  • sudden body shock after severe vomiting, diarrhea, small amount of fluid intake, abuse of diuretics;
  • increased glucose levels in the liver caused by decompensation or improper treatment;
  • excessive glucose concentration after administration of intravenous solutions.

After this, the functioning of the kidneys is disrupted, which affects the excretion of glucose in the urine, and its excess is toxic to the entire body. This in turn suppresses the production of insulin and the utilization of sugar by other tissues. As a result, the patient’s condition worsens, blood flow decreases, dehydration of brain cells is observed, blood pressure decreases, a disorder in consciousness occurs, hemorrhages are possible, failures occur in the life support system and the person falls into a coma.

The doctor must differentiate the pathology from, so as not to aggravate the situation by prescribing diuretics. Done computed tomography heads.

When installed accurate diagnosis, the patient is hospitalized and treatment is prescribed.

Treatment

Emergency assistance consists of the following:

  • called ambulance;
  • pulse and blood pressure are checked before the doctor arrives;
  • the patient’s speech apparatus is checked, the earlobes should be rubbed, the cheeks should be slapped so that the patient does not lose consciousness;
  • If the patient is on insulin, insulin is injected subcutaneously and plenty of brackish water is provided.

After hospitalizing the patient and determining the cause, appropriate treatment is prescribed depending on the type of coma.

Hyperosmolar coma involves the following therapeutic actions:

  • elimination of dehydration and state of shock;
  • restoration of electrolyte balance;
  • blood hyperosmolarity is eliminated;
  • if detected, withdrawal and normalization of lactic acid is undertaken.

The patient is hospitalized, the stomach is washed, a urinary catheter is inserted, and oxygen therapy is performed.

With this type of coma, rehydration is prescribed in large volumes: it is much higher than in ketoacidotic coma, in which rehydration is also prescribed, as well as insulin therapy.

The disease is treated by restoring the volume of fluid in the body, which can contain both glucose and sodium. However, in this case there is a very high risk of death.

In hyperglycemic coma there is increased insulin, therefore it is not prescribed, but instead a large amount of potassium is administered. Use of alkalis and baking soda not attempted in ketoacidosis or hyperosmolar coma.

  • take prescribed medications in a timely manner;
  • do not exceed the prescribed dosage;
  • control blood sugar, get tested more often;
  • control blood pressure, use medications that help normalize it.

Do not overwork, get plenty of rest, especially during rehabilitation.

Possible complications

The most common complications of hyperosmolar coma are:

  • epileptic seizures;
  • liver problems;
  • paralysis;
  • speech problems.

At the first manifestations of clinical symptoms, the patient must be provided with medical care, examination and treatment.

Coma in children is more common than in adults and is characterized by extremely negative prognosis. Therefore, parents need to monitor the baby’s well-being and seek medical help at the first symptoms.

Prevention

Preventive measures will consist of following clinical recommendations, compliance dietary nutrition, controlling your condition. If the first signs of illness appear, consult a doctor immediately.

Patients with hyperosmolar coma should be hospitalized in the intensive care unit. After diagnosis and initiation of therapy, patients need constant monitoring of their condition, including monitoring of basic hemodynamic parameters, body temperature and laboratory parameters.

If necessary, patients undergo mechanical ventilation and catheterization bladder, installation of central venous catheter, parenteral nutrition. In the intensive care unit the following is carried out:

  • express blood glucose test once an hour intravenous administration glucose or 1 time 3 hours when switching to subcutaneous administration;
  • determination of ketone bodies in serum in the blood 2 times a day (if impossible, determination of ketone bodies in urine 2 times a day);
  • determination of K and Na levels in the blood 3-4 times a day;
  • study of the acid-base state 2-3 times a day until stable normalization of pH;
  • hourly monitoring of diuresis until dehydration is eliminated;
  • ECG monitoring,
  • monitoring blood pressure, heart rate, body temperature every 2 hours;
  • X-ray of the lungs,
  • general analysis blood, urine once every 2-3 days.

As with diabetic ketoacidosis, the main directions of treatment for patients with hyperosmolar coma are rehydration, insulin therapy (to reduce plasma glycemia and hyperosmolarity), correction of electrolyte disorders and acid-base disorders).

Rehydration

Sodium chloride, 0.45 or 0.9% solution, intravenous drip 1-1.5 l during the 1st hour of infusion, 0.5-1 l during the 2nd and 3rd, 300-500 ml per subsequent hours. The concentration of sodium chloride solution is determined by the level of sodium in the blood. At a Na + level of 145-165 meq/l, a sodium chloride solution is administered at a concentration of 0.45%; at a Na + level of 165 mEq/L, the administration of saline solutions is contraindicated; in such patients, glucose solution is used for rehydration.

Dextrose, 5% solution, 1-1.5 liters intravenously during the 1st hour of infusion, 0.5-1 liters during the 2nd and 3rd hours, 300-500 ml in the following hours. Osmolality of infusion solutions:

  • 0.9% sodium chloride - 308 mOsm/kg;
  • 0.45% sodium chloride - 154 mOsm/kg,
  • 5% dextrose - 250 mOsm/kg.

Adequate rehydration helps reduce hypoglycemia.

Insulin therapy

Apply medicines short acting:

Soluble insulin (human genetically engineered or semi-synthetic) intravenously in a sodium chloride/dextrose solution at a rate of 00.5-0.1 U/kg/h (in this case, the blood glucose level should decrease by no more than 10 mOsm/kg/ h).

In the case of a combination of ketoacidosis and hyperosmolar syndrome, treatment is carried out in accordance with general principles treatment of diabetic ketoacidosis.

Evaluation of treatment effectiveness

Signs effective therapy hyperosmolar coma serves to restore consciousness, eliminate clinical manifestations hyperglycemia, achieving target blood glucose levels and normal plasma osmolality, disappearance of acidosis and electrolyte disorders.

Errors and unreasonable assignments

Rapid rehydration and a sharp decrease in blood glucose levels can lead to rapid decline plasma osmolarity and the development of cerebral edema (especially in children).

Considering old age patients and the presence of concomitant diseases, even adequate rehydration can often lead to decompensation of heart failure and pulmonary edema.

A rapid decrease in blood glucose levels can cause extracellular fluid to move into cells and worsen arterial hypotension and oliguria.

The use of potassium even with moderate hypokalemia in persons with oligo- or anuria can lead to life threatening hyperkalemia.

The administration of phosphate in renal failure is contraindicated.

Diabetes mellitus is a disease of the 21st century. More and more people are learning that they have this terrible disease. However, a person can live well with this disease, the main thing is to follow all the doctors’ instructions.

Unfortunately, in severe cases of diabetes, a person may experience hyperosmolar coma.

What is this?

Hyperosmolar coma is a complication of diabetes mellitus, in which a serious metabolic disorder occurs. This condition is characterized by the following:

  • hyperglycemia - a sharp and strong increase in blood glucose levels;
  • hypernatremia - increased sodium levels in the blood plasma;
  • hyperosmolarity - an increase in the osmolarity of blood plasma, i.e. the sum of the concentrations of all active particles per 1 liter. blood greatly exceeds normal value(from 330 to 500 mosmol/l with a norm of 280-300 mosmol/l);
  • dehydration is the dehydration of cells that occurs as a result of fluid rushing into the intercellular space to reduce sodium and glucose levels. It occurs throughout the body, even in the brain;
  • absence of ketoacidosis – blood acidity does not increase.

Hyperosmolar coma most often occurs in people over 50 years of age and accounts for approximately 10% of all types of coma in diabetes mellitus. If you do not provide emergency assistance to a person in this condition, this can lead to death.

Reasons

There are a number of reasons that can lead to this type of coma. Here are some of them:

  • Dehydration of the patient's body. This may include vomiting, diarrhea, decreased fluid intake, or prolonged use of diuretics. Burns of a large surface of the body, disorders of the kidneys;
  • Lack or absence of the required amount of insulin;
  • Unrecognized diabetes mellitus. Sometimes a person does not even suspect that he has this disease, so he does not undergo treatment and does not follow a certain diet. As a result, the body cannot cope and a coma may occur;
  • Increased need for insulin, for example, when a person breaks his diet by eating foods containing large amounts of carbohydrates. This need may also arise when colds, diseases genitourinary system infectious nature, with long-term use glucocorticosteroids or medicines, replaceable sex hormones;
  • Taking antidepressants;
  • Diseases that arise as complications after the underlying disease;
  • Surgical interventions;
  • Acute infectious diseases.

Symptoms

Hyperosmolar coma, like any disease, has its own signs by which it can be recognized. Moreover, this condition develops gradually. Therefore, some symptoms predict in advance the occurrence of hyperosmolar coma. The signs are as follows:

  • A few days before a coma, a person experiences severe thirst and constant dry mouth;
  • The skin becomes dry. The same applies to mucous membranes;
  • The tone of soft tissues decreases;
  • A person constantly experiences weakness and lethargy. Constantly want to sleep, which leads to coma;
  • Pressure drops sharply, tachycardia may occur;
  • Polyuria develops - increased urine production;
  • Speech problems and hallucinations may occur;
  • Muscle tone may increase, convulsions or paralysis may occur, but the tone of the eyeballs, on the contrary, may decrease;
  • Very rarely, epileptic seizures may occur.

Diagnostics

In blood tests, a specialist determines elevated levels glucose and osmolarity. In this case, there are no ketone bodies.

Diagnosis is also based on visible symptoms. In addition, the patient’s age and the course of his disease are taken into account.

To do this, the patient must take tests to determine glucose, sodium and potassium in the blood. Urine is also given to determine the level of glucose in it. In addition, doctors can prescribe an ultrasound and x-ray of the pancreas and its endocrine part and electrocardiography.

Treatment

Emergency care for hyperosmolar coma consists, first of all, in eliminating dehydration of the body. Then it is necessary to restore blood osmolarity and normalize glucose levels.

A patient who experiences hyperosmolar coma should be urgently taken to the intensive care unit or intensive care unit. After a diagnosis has been made and treatment has begun, the condition of such a patient is under constant monitoring:

  • A rapid blood test must be done once an hour;
  • Twice a day, ketone bodies in the blood are determined;
  • Several times a day they do an analysis to determine the level of potassium and sodium;
  • Check the acid-base status a couple of times a day;
  • The amount of urine produced over time is constantly monitored until dehydration is corrected;
  • ECG and blood pressure monitoring;
  • Every two days a general analysis of urine and blood is performed;
  • They may do x-rays of the lungs.

Sodium chloride is used for rehydration. It is administered intravenously using a dropper in certain quantities. The concentration is selected depending on the amount of sodium contained in the blood. If the level is high enough, then a glucose solution is used.

In addition, a dextrose solution is used, which is also administered intravenously.

In addition, the patient in a state of hyperosmolar coma is given insulin therapy. Short-acting insulin is used and is administered intravenously.

Emergency first aid

But what should a person do if a loved one develops a hyperosmolar coma completely unexpectedly (this happens when a person does not pay attention to the symptoms).

You need to proceed as follows:

  • Be sure to ask someone to call a doctor;
  • The patient should be well covered or covered with heating pads. This is done in order to reduce heat loss;
  • It is necessary to monitor body temperature and breathing status;
  • It is necessary to check the condition of the eyeballs, skin tone;
  • Monitor glucose levels;
  • If you have experience, you can put in a drip with saline solution. 60 drops should pass per minute. The volume of the solution is 500 ml.

Complications

Hyperosmolar coma often occurs in people over 50 years of age. Therefore, sometimes certain complications may arise. For example:

  • With rapid rehydration and decreased glucose, cerebral edema may occur;
  • Due to the fact that this condition often occurs in older people, heart problems and pulmonary edema are likely to develop;
  • If glucose levels decrease very quickly, a sharp decrease in blood pressure is possible;
  • Using potassium may cause it great content in the body, which can become a threat to human life.

Forecast

Hyperosmolar coma is considered a severe complication of diabetes mellitus. Fatal outcome occurs in approximately 50% of cases of this condition. After all, most often it appears at an age when, in addition to diabetes, a person may have many other diseases. And they are the ones who can cause a difficult recovery.

If assistance is provided on time, the prognosis is favorable; the most important thing is that after leaving this state, the patient follows all the doctor’s instructions and adheres to healthy eating and lifestyle in general. And his close people need to know the rules emergency care in order to provide it on time if necessary.