Diabetic coma in children

Diabetes patients wonder: diabetic coma: what is it? What does a diabetic expect if you don’t take insulin on time and prevent preventive therapy? And the most important question that worries patients of endocrine departments in clinics: If blood sugar is 30, what should I do? And what is the limit to coma?
It will be more correct to talk about diabetic coma, since 4 types of coma are known. The first three are hyperglycemic, associated with an increased concentration of sugar in the blood.

Ketoacidotic coma

Ketoacidotic coma is characteristic of patients with type 1 diabetes. This critical condition occurs due to insulin deficiency, as a result of which glucose utilization is reduced, metabolism at all levels is degraded, and this leads to a malfunction of the functions of all systems and individual organs. The main etiological factor of ketoacidotic coma is insufficient insulin administration and a sharp jump in blood glucose. Hyperglycemia reaches - 19-33 mmol / l and higher. The result is a deep faint.

Usually, a ketoacidotic coma develops within 1-2 days, but in the presence of provoking factors, it can develop faster. The first manifestations of a diabetic precoma are signs of an increase in blood sugar: increasing lethargy, a desire to drink, polyuria, an acetone breath. The skin and mucous membranes are overdried, abdominal pains, headaches appear. As the coma increases, polyuria can be replaced by anuria, blood pressure drops, pulse increases, muscle hypotension is observed. If the blood sugar concentration is above 15 mmol / l, the patient must be placed in a hospital.

Ketoacidotic coma is the last degree of diabetes, expressed by complete loss of consciousness, and if you do not provide assistance to the patient, death may occur. Emergency assistance should be called immediately.

For untimely or insufficient administration of insulin, the following reasons serve:

  • The patient does not know about his disease, did not go to the hospital, so diabetes was not detected in a timely manner.
  • The injected insulin is not of appropriate quality, or is expired,
  • A gross violation of the diet, the use of easily digestible carbohydrates, an abundance of fats, alcohol, or prolonged starvation.
  • The desire for suicide.

Patients should know that with type 1 diabetes, the need for insulin increases in the following cases:

  • during pregnancy
  • with concomitant infections,
  • in cases of injuries and surgeries,
  • with prolonged administration of glucocorticoids or diuretics,
  • during physical exertion, psychoemotional stressful conditions.

The pathogenesis of ketoacidosis

Insulin deficiency is a consequence of increased production of corticoid hormones - glucagon, cortisol, catecholamines, adrenocorticotropic and somatotropic hormones. Glucose is blocked from entering the liver, into the cells of muscles and adipose tissue, its level in the blood rises, and a state of hyperglycemia occurs. But at the same time, cells experience energy hunger. Therefore, patients with diabetes experience a state of weakness, powerlessness.

In order to somehow replenish energy hunger, the body starts other mechanisms of energy replenishment - it activates lipolysis (decomposition of fats), as a result of which free fatty acids, unesterified fatty acids, triacylglycerides are formed. With insulin deficiency, 80% of the energy the body receives during the oxidation of free fatty acids, accumulates by-products of their decomposition (acetone, acetoacetic and β-hydroxybutyric acids), which make up the so-called ketone bodies. This explains the sharp weight loss of diabetics. An excess of ketone bodies in the body absorbs alkaline reserves, as a result of which ketoacidosis develops - a severe metabolic pathology. Simultaneously with ketoacidosis, water-electrolyte metabolism is disturbed.

Hyperosmolar (non-ketoacidotic) coma

Hyperosmolar coma is prone to patients with type 2 diabetes. This type of coma in diabetes mellitus occurs due to lack of insulin, and is characterized by a sharp dehydration of the body, hyperosmolarity (increased concentration of sodium, glucose and urea in the blood).

Hyperosmolarity of blood plasma leads to serious impairment of body functions, loss of consciousness, but in the absence of ketoacidosis, which is explained by the production of insulin by the pancreas, it is still insufficient to eliminate hyperglycemia.

The dehydration of the body, which is one of the causes of diabetic hyperosmolar coma, is

  • excessive use of diuretics,
  • diarrhea and vomiting of any etiology,
  • living in hot climates, or working in elevated temperatures,
  • lack of drinking water.

The following factors also affect the onset of coma:

  • Insulin deficiency
  • Concomitant diabetes insipidus,
  • Abuse of foods containing carbohydrates, or large doses of glucose injections,
  • or peritoneal dialysis, or hemodialysis (procedures related to cleansing the kidneys or peritoneum).
  • Prolonged bleeding.

The development of hyperosmolar coma has common signs with a ketoacidotic coma. How long the precomatous state lasts depends on the state of the pancreas, its ability to produce insulin.

Hyperlactacidemic coma and its consequences

Hyperlactacidemic coma occurs due to the accumulation of lactic acid in the blood due to a lack of insulin. This leads to a change in the chemical composition of the blood and loss of consciousness. The following factors are capable of provoking hyperlactacidemic coma:

  • Insufficient amount of oxygen in the blood due to heart and respiratory failure arising in the presence of pathologies such as bronchial asthma, bronchitis, circulatory failure, cardiac pathologies,
  • Inflammatory diseases, infections,
  • Chronic kidney or liver disease
  • Lingering alcoholism

The main cause of hyperlactacidemic coma is a lack of oxygen in the blood (hypoxia) against a background of insulin deficiency. Hypoxia stimulates anaerobic glycolysis, which produces an excess of lactic acid. Due to a lack of insulin, the activity of the enzyme that promotes the conversion of pyruvic acid to acetyl coenzyme is reduced. As a result, pyruvic acid is converted to lactic acid and accumulates in the blood.

Due to oxygen deficiency, the liver is unable to utilize excess lactate. Altered blood causes a violation of contractility and excitability of the heart muscle, narrowing of peripheral vessels, resulting in coma

The consequences, and at the same time, symptoms of hyperlactacidemic coma are muscle pain, angina pectoris, nausea, vomiting, drowsiness, blurred consciousness.

Knowing this, you can prevent the onset of coma, which develops within a few days, if you put the patient in a hospital.

All of the above types of com are hyperglycemic, that is, developing due to a sharp increase in blood sugar. But a reverse process is also possible, when the sugar level drops sharply, and then a hypoglycemic coma can occur.

Hypoglycemic coma

Hypoglycemic coma in diabetes mellitus has a reverse mechanism, and can develop when the amount of glucose in the blood is reduced so much that an energy deficiency occurs in the brain.

This condition occurs in the following cases:

  • When an overdose of insulin or sugar-lowering oral drugs is allowed,
  • The patient after eating insulin did not eat on time, or the diet was low in carbohydrates,
  • Sometimes the adrenal function decreases, the insulin-inhibiting ability of the liver, as a result, insulin sensitivity increases.
  • After intense physical work,

Poor supply of glucose to the brain provokes hypoxia and, as a result, impaired metabolism of proteins and carbohydrates in the cells of the central nervous system.

  • Increased hunger
  • decreased physical and mental performance,
  • a change in mood and inappropriate behavior, which can be expressed in excessive aggression, feelings of anxiety,
  • hand shake
  • tachycardia,
  • pallor,
  • High blood pressure

With a decrease in blood sugar to 3.33-2.77 mmol / l (50-60 mg%), the first mild hypoglycemic phenomena occur. In this condition, you can help the patient by giving him drink warm tea or sweet water with 4 pieces of sugar. Instead of sugar, you can put a spoonful of honey, jam.

At a blood sugar level of 2.77-1.66 mmol / l, all the signs characteristic of hypoglycemia are observed. If there is a person near the patient who can give injections, glucose can be introduced into the blood. But the patient will still have to go to hospital for treatment.

With a sugar deficiency of 1.66-1.38 mmol / L (25-30 mg%) and lower, consciousness is usually lost. Urgently need to call an ambulance.

What is a diabetic coma and what are its causes and types?

The definition of a coma is diabetic - characterizes a condition in which a diabetic loses consciousness when there is a deficiency or an excess of glucose in the blood. If in this condition the patient will not be given emergency care, then everything can be fatal.

The leading causes of diabetic coma are the rapid increase in blood glucose concentration, which is caused by insufficient secretion of insulin by the pancreas, lack of self-control, illiterate therapy and others.

Without enough insulin, the body cannot process glucose because of what it does not turn into energy. Such a deficiency leads to the fact that the liver begins to independently produce glucose. Against this background, there is an active development of ketone bodies.

So, if glucose accumulates in the blood faster than ketone bodies, then a person loses consciousness and develops a diabetic coma. If the sugar concentration increases along with the content of ketone bodies, then the patient may fall into a ketoacidotic coma. But there are other types of such conditions that should be considered in more detail.

In general, these types of diabetic coma are distinguished:

  1. hypoglycemic,
  2. hyperglycemic,
  3. ketoacidotic.

Hypoglycemic coma - may occur when the sugar level in the blood stream suddenly drops. How long this condition will last cannot be said, because a lot depends on the severity of hypoglycemia and the health of the patient. This condition is susceptible to diabetics skipping meals or those who do not follow the dosage of insulin. Hypoglycemia also appears after overstrain or alcohol abuse.

The second type - hyperosmolar coma occurs as a complication of type 2 diabetes, which causes a lack of water and excessive blood sugar. Its onset occurs with a glucose level of more than 600 mg / l.

Often, excessive hyperglycemia is compensated by the kidneys, which remove excess glucose with urine. In this case, the reason for the development of coma is that during dehydration created by the kidneys, the body is forced to save water, because of which severe hyperglycemia can develop.

Hyperosmolar s. diabeticum (Latin) develops 10 times more often than hyperglycemia. Basically, its appearance is diagnosed with type 2 diabetes in elderly patients.

Ketoacidotic diabetic coma develops with type 1 diabetes. This type of coma can be observed when ketones (harmful acetone acids) accumulate in the body. They are by-products of fatty acid metabolism resulting from acute deficiency of the hormone insulin.

Hyperlactacidemic coma in diabetes occurs extremely rarely. This variety is characteristic of elderly patients with impaired liver, kidney and heart function.

The reasons for the development of this type of diabetic coma are increased education and poor utilization of hypoxia and lactate. So, the body is poisoned with lactic acid, accumulated in excess (2-4 mmol / l). All this leads to a violation of the balance of lactate-pyruvate and the appearance of metabolic acidosis with a significant anionic difference.

A coma arising from type 2 or type 1 diabetes is the most common and dangerous complication for an adult who is already 30 years old. But this phenomenon is especially dangerous for minor patients.

Diabetic coma in children often develops with an insulin-dependent form of the disease that lasts for many years. Diabetic comas in children often appear at preschool or school age, sometimes in the chest.

Moreover, under the age of 3 years, such conditions occur much more often than in adults.

Symptomatology

Types of coma and diabetes are different, so their clinical picture may be different. So, for ketoacidotic coma, dehydration is characteristic, accompanied by a loss in weight of up to 10% and dry skin.

In this case, the face turns painfully pale (occasionally turns red), and the skin on the soles, palms turns yellow, itches and peels. Some diabetics have furunculosis.

Other symptoms of a diabetic coma with ketoacidosis are a rotten breath, nausea, vomiting, muscle lethargy, limb cooling, and low temperature. Due to intoxication of the body, hyperventilation of the lungs can occur, and breathing becomes noisy, deep and frequent.

When a type of diabetes occurs in type 2 diabetes, its symptoms also include a decreased tone of the eyeballs and a narrowing of the pupils. Occasionally, prolapse of the upper eyelid and strabismus are noted.

Also, developing ketoacidosis is accompanied by frequent spontaneous urination, in which the discharge has a fetal smell. At the same time, the stomach hurts, intestinal motility is weakened, and the level of blood pressure is reduced.

Ketoacidotic coma in diabetics can have different degrees of severity - from drowsiness to lethargy. Intoxication of the brain contributes to the onset of epilepsy, hallucinations, delirium and confusion.

Hyperosmolar diabetic coma signs:

  • cramps
  • dehydration,
  • speech impairment
  • malaise,
  • neurological symptoms
  • involuntary and rapid movements of the eyeball,
  • rare and weak urination.

Signs of diabetic coma with hypoglycemia are slightly different from other types of coma. This condition can be characterized by severe weakness, hunger, causeless anxiety and fear, chills, trembling and sweating of the body. The consequences of diabetic coma with hypoglycemia are loss of consciousness and the appearance of seizures.

Hyperlactacidemic diabetic coma is characterized by dry tongue and skin, Kussmaul type breathing, collapse, hypotension, and decreased turgor. Also, a coma period, lasting from a couple of hours to several days, is accompanied by tachycardia, oliguria, passing into anuria, softness of the eyeballs.

Hypoglycemic coma and other types of similar conditions in children develop gradually. Diabetic precoma is accompanied by abdominal discomfort, anxiety, thirst, drowsiness, headache, poor appetite and nausea. As it develops, the patient’s breathing becomes noisy, deep, the pulse is rapid, and arterial hypotension appears.

In diabetes mellitus in infants, when the child begins to fall into a coma, he develops polyuria, constipation, polyphagy and increased thirst. His diapers become hard from urine.

In children, it manifests the same symptoms as in adults.

What to do with a diabetic coma?

If first aid for complications of hyperglycemia is not timely, then a patient with a diabetic coma whose consequences are extremely dangerous can result in pulmonary and cerebral edema, thrombosis, leading to heart attacks and strokes, oliguria, renal or respiratory failure, and others. Therefore, after the diagnosis has been carried out, the patient should immediately be given help with a diabetic coma.

So, if the patient's condition is close to fainting, then an urgent emergency call must be made. While she will be driving, it is necessary to lay the patient on his stomach or on his side, enter the duct and prevent the tongue from dropping. If necessary, normalize the pressure.

What to do with a diabetic coma caused by an excess of ketones? In this situation, the algorithm of actions is to normalize the vital functions of the diabetic, such as pressure, heartbeat, consciousness and breathing.

If lactatacidemic coma has developed in diabetes mellitus, it is necessary to take the same measures as in case of ketoacidotic. But in addition to this, water-electrolyte and acid-base balance should be restored. Also, help with a diabetic coma of this type consists in administering a glucose solution with insulin to the patient and performing symptomatic therapy.

If a mild hypoglycemic coma occurs in type 2 diabetes, self-help is possible. This period will not last long, so the patient should have time to take fast carbohydrates (a few sugar cubes, a spoonful of jam, a glass of fruit juice) and take a comfortable position so as not to injure himself in case of loss of consciousness.

If it is provoked by insulin, the effect of which lasts a long time, then eating with a diabetic coma involves taking slow carbohydrates in an amount of 1-2 XE before bedtime.

Emergency care for endocrine-related conditions

Those parents who believe that the information collected in this article will never be useful to them and their healthy children will close the page and will not get acquainted with the material. Right and far-sighted will be those who understand that diseases of the endocrine glands almost always develop in previously healthy people and conditions requiring first aid often arise against the background of seemingly complete health. Such conditions, first of all, include coma - hypoglycemic and diabetic, the rules of salvation under which this article is dedicated.

Two considerations made us dwell on hypoglycemic and diabetic coma. Firstly, it is these conditions that most often occur suddenly, in patients with diabetes mellitus, and sometimes in seemingly healthy children, requiring quick, coordinated and correct actions from parents and adults nearby. Secondly, the symptoms of these coms are quite specific, and even an adult eyewitness who is not related to medicine will be able to understand them and, with a presumptive diagnosis, provide the necessary first aid.

For those who do not know, both coma - both diabetic and hypoglycemic - are complications of the uncompensated form of diabetes. However, the mechanisms of development of these conditions are fundamentally different: if the hypoglycemic coma is based on a sharp drop in blood sugar caused by various reasons, hypoglycemia, then a long-term uncompensated high level of blood glucose, hyperglycemia, leads to a diabetic coma. Diagnosis, treatment, and even first aid to a child with a coma of endocrine origin is based on this difference.

Hypoglycemic condition and hypoglycemic coma

So, hypoglycemia. The low blood sugar level of a patient with diabetes is extremely dangerous, primarily due to the fact that without the glucose - an energy source - not a single organ of the human body can function normally. And the brain is the first to suffer in this situation, which causes the symptoms characteristic of hypoglycemia. The most common causes of hypoglycemia are eating disorders (skipping meals), inadequate carbohydrate-rich foods, intense physical activity (again, not adjusted by diet and changes in insulin administration), an error in insulin dosing, and repeated vomiting and / or diarrhea, which reduces the body's need for insulin. Hypoglycemic conditions more often occur before lunch or at night, less often - in the morning or in the afternoon. Hypoglycemia often occurs in preschool and school children with diabetes and very rarely in infants.

Although hypoglycemia is characterized by a rapid increase in the number and severity of symptoms, a change in the patient's condition usually goes through several successive stages. A mild form of hypoglycemia in children is characterized by general malaise, anxiety, a sense of fear, distraction, disobedience, excessive sweating (the appearance of unexplained perspiration), pale skin, palpitations, muscle tremors. The appearance of a feeling of hunger is characteristic, there may be a sensation of creeping goosebumps on the body, a feeling of getting hair or villi in the mouth or on the skin around it, slurred speech is sometimes noted. If timely assistance is not provided, the child’s condition continues to worsen, symptoms of severe hypoglycemia appear, which include confusion, inability to concentrate, pronounced impaired speech, vision and motor coordination, making the child look like a person who is intoxicated. The child may become aggressive or eccentric, then lose consciousness. Often in children, hypoglycemia causes seizures similar to an epileptic seizure.

A further drop in blood sugar leads the child to a state of hypoglycemic coma, which is characterized by the following picture. The child is unconscious, he is pale and wet due to intense sweating. Convulsions periodically occur, there is a sharply rapid heartbeat against the background of almost normal rhythmic breathing. An important distinguishing feature of a hypoglycemic coma from a diabetic is the lack of a smell of acetone in exhaled air. Using a portable glucometer helps in the diagnosis of hypoglycemic conditions - the level of glucose in the blood with hypoglycemia is significantly lower than the lower limit of the norm, which is 3.3 mmol / L for people of all ages.

First aid. With the onset of early symptoms of hypoglycemia (mild stage of hypoglycemia), a necessary and sufficient measure is the ingestion of a small amount of easily digestible carbohydrates. A conscious child with hypoglycemia should be given a piece of sugar, candy, jam, honey, glucose in tablets, a little fruit juice or a non-diet soft drink (fanta, sprite, lemonade, Pepsi, etc.). If the child’s condition does not improve, the intake of the sugar-containing product must be repeated, and then call the ambulance team. Pouring sweet drinks into the mouth of a patient in an unconscious state is by no means possible - the liquid can enter the lungs and lead to the death of the child.

Intramuscular administration of glucagon, a hormone that releases internal glucose from the liver, also refers to first-aid measures for hypoglycemia. Usually this drug is in the home medicine cabinet of patients with diabetes - doctors strongly recommend that you keep it in a place accessible and well known to the relatives and relatives of the sick child. Glucagon can be administered both in the presence of consciousness and in the unconscious state of a patient with hypoglycemia.

If a child is found with signs of hypoglycemic coma, the following steps must be performed. First of all, it is necessary to ensure free access of oxygen to the lungs - for this purpose the buttons on the collar are unfastened, the belt loosens or loosens, a window or window opens. It is necessary to turn the child on its side (to prevent the tongue from sticking) and clean the contents of the oral cavity (vomit, food debris, etc.). This is followed by a call to the ambulance team and in parallel (if available) 1 mg of glucagon is administered intramuscularly.

In no case should you inject insulin (even if the drug is found in the things of the victim) - in the presence of a hypoglycemic coma, insulin administration can lead to fatal consequences.

No less dangerous than hypoglycemia is the condition of a long-lasting elevated blood sugar level characteristic of the decompensated form of diabetes mellitus. Hyperglycemia is accompanied by impaired metabolism of fats and proteins with the formation of ketone bodies and acetone - extremely toxic substances that accumulate in the body and cause severe damage to internal organs. Given these metabolic disorders, this form of diabetes mellitus decompensation is called ketoacidosis, and the coma that occurs with severe ketoacidosis is called ketoacidotic coma.

Unlike hypoglycemia, ketoacidosis develops slowly, making it possible to diagnose the condition and help the child. However, sometimes (for example, in infants), the rate of development of ketoacidosis is significantly accelerated and provokes coma in a very short time. The reason for the development of ketoacidosis and diabetic (ketoacidotic) coma is insulin therapy with insufficient doses of the hormone, an increase in the body's need for insulin against a background of various diseases, intoxications, stress, injuries, surgery and certain medications.

The initial stage of ketoacidosis in children is accompanied by anxiety, lack of appetite due to severe thirst, headache, nausea, vomiting, abdominal pain, which can mimic acute diseases of the digestive system. Dry tongue and lips, profuse and frequent urination and drowsiness are noted. In the future, a gradual loss of consciousness occurs, convulsions develop, breathing becomes deep and noisy, and the pulse becomes frequent and weak. The skin of a child with ketoacidosis is cold, dry, flaky and inelastic. A symptom typical of ketoacidosis is the appearance of a smell of acetone from the mouth. If there is a glucometer within your reach and you have the skills to use it, you can determine the blood sugar level in a child - with ketoacidosis there is a very high glycemia level - above 16-20 mmol / l.

First aid. When the first signs of ketoacidosis appear, it is, of course, necessary to urgently show the doctor. Even if insulin was administered to the sick baby regularly and at the prescribed doses, the development of ketoacidosis indicates insufficient therapy and the need for urgent correction. In some cases, an endocrinologist’s telephone consultation is acceptable, but as soon as the opportunity for a face-to-face visit presents itself, it must be used immediately. In the patient's diet, the fat content is limited, alkaline drink is prescribed - alkaline mineral waters, soda solution, rehydron.

Assisting a child in an unconscious state with signs of a ketoacidotic coma should in no case begin with the introduction of insulin. Paradoxically, insulin in such a situation can kill the patient. The thing is that insulin, having got into the patient’s body in a ketoacidotic coma, triggers an intensive flow of glucose from the blood to the cells, while glucose “draws” excess water with it, which leads to the development of cellular and tissue edema. Edema of the internal organs and, above all, the brain, also causes the fatal consequences of early insulin therapy, which is not supported by other drugs necessary in this situation. Insulin will be required to be administered - but then, after the arrival of the ambulance crew and the hospitalization of the child. In the meantime, remember - no insulin!

The main task of the rescuer in such a situation is to maintain the vital functions of the child’s body before the doctors arrive (ambulance should be called immediately after finding a child who is unconscious). For this purpose, the child must be turned on his stomach, ensuring the airway, free his mouth from foreign bodies, food and vomit. The airway and the nature of breathing will need to be observed during the entire waiting period for the ambulance crew - this is the main task of an unqualified rescuer and the main non-specialized care necessary for a child in a state of ketoacidotic coma.

Coma and the condition preceding it are a force majeure, stressful situation that can unsettle even a mentally stable adult. But we must remember that not only health, but also the life of the child depends on the correctness, coherence, accuracy and speed of rescue measures in this situation. It is necessary to get together as much as possible and concentrate on the actions performed. And emotions can be left for later. Take care of your health!

Features of hypo- and hyperglycemic state in children

Sugar sick child diabetes , often experiences certain individual sensations when increasing and decreasing the amount of sugar in the blood. Hypoglycemic coma occurs as a result of a sharp

and a sudden drop in blood sugar, with an overdose of insulin or with insufficient food intake after an injection of insulin.

The child turns pale, becomes lethargic and may be on the verge of losing consciousness,

It doesn’t behave as it always does, it can calm down, pacify or, conversely, become aggressive,

A shiver can beat him

The child sweats profusely, but his skin is cold,

The child’s breathing often becomes frequent, superficial and intermittent, but there will be no smell of acetone in it,

Often there is nausea or headaches,

The child will experience some confusion - he does not always correctly answer the simplest questions.

If during this period the child is not given anything sweet (preferably in the form of a drink), then he may lose consciousness and all the signs of a hypoglycemic coma will develop.

If you notice a number of signs that indicate hypoglycemia in a child, you must immediately do the following:

Give him a piece of sugar, a glucose drink (or glucose tablets), or any other sweet food. When improving, give him sweets again,

After the condition improves, show the child to the doctor and find out why his condition worsened, whether the dose of insulin should be reviewed,

If you lose consciousness, first check

airway of the child, and if breathing stops, start do artificial respiration ,

At the same time, ask someone to urgently call an ambulance. When calling, be sure to inform that the child has a hypoglycemic coma,

When the first signs of hypoglycemia appear, the child should not be left alone at school or at home for a minute!

HYPERGLYCEMIA in a child also has its own characteristics. Diabetic coma (hyperglycemia) develops in children with late diagnosis and the lack of necessary therapeutic assistance at the onset of the disease.Also in its occurrence can play a role such factors as violations of the regime, emotional overload, an joined infection. Signs of a diabetic coma in a child:

The child often visits the toilet,

The skin becomes hot to the touch, the face “burns”,

He becomes lethargic and sleepy,

Complains of poor health

A child constantly complains of thirst

Nausea and vomiting appear

The smell of air exhaled by a child resembles the smell of acetone or rotting apples,

Breathing becomes frequent and shallow.

If at this time the child is not assisted, then he

will lose consciousness and a state of hyperglycemic coma will come.

When the first signs of hyperglycemia appear, the following measures should be taken:

Ask the child if he has eaten what is not appropriate for him,

Find out if an insulin injection is given

Show the child to the attending physician,

If the child is unconscious, you need to check the airway and make sure that his breathing is normal,

If breathing has stopped - immediately start doing mouth-to-mouth artificial respiration,

It is urgent to call an ambulance. When calling, it must be said that perhaps the child diabetic coma .

Treatment of diabetes in children should be comprehensive, with the mandatory use of insulin and diet therapy. Treatment should include not only the relief of the course of the disease, but also the provision of proper physical development. Nutrition should be close to the age physiological norm, but with a restriction of fat and sugar. The use of high-grade carbohydrates should be limited. With an increase in the liver, all spicy and fried foods should be excluded from the child’s diet, food should be steamed. The daily dose of insulin is set strictly individually, taking into account the daily glycosuria. The daily dose of insulin prescribed for the first time can be easily calculated by dividing the daily loss of sugar in urine by five. All changes in the appointment of the dosage of insulin should only be done by an endocrinologist.

After the disappearance of coma symptoms, coffee, tea, crackers, broth, mashed apple, minced meat, fruit juices are prescribed. Gradually switch to a nutritious diet with limited fat. When wedged

compensation, you can transfer the patient to combination treatment with the use of prolonged insulin.

Diabetes mellitus in children

LudmilaSeptember 6, 2011Endocrine Diseases in ChildrenNo Comments

Refers to the most common endocrine disease.

Etiology and pathogenesis . The proportion of children from diabetes is relatively low (8-10%), but diabetes in childhood occurs with a high degree of insulin deficiency, which determines the severity of its course. In the etiology of diabetes there are many unresolved issues.

Diabetes mellitus in children is mainly a hereditary disease; the nature of the gene defect remains unclear. The polygenic nature of inheritance involving a number of factors is recognized. Now insulin-dependent diabetes mellitus is attributed to autoimmune diseases, the occurrence of which is more common after infectious diseases. The presence of insulin is confirmed in the pancreas, the result of the development of which is insulin deficiency. As a result of insulin deficiency, various metabolic disorders develop, the main of which are disorders of carbohydrate metabolism, the development of hyperglycemia, glucosuria, polyuria. Fat metabolism is impaired (increased lipolysis, decreased lipo-synthesis, increased formation of unesterified fatty acids, ketone bodies, cholesterol). Violation of the combustion of carbohydrates in muscle tissue leads to lactic acidosis. Acidosis is also due to an increase in neogenesis. As a result, insulin deficiency also disrupts protein and water-mineral metabolism.

To detect preclinical disorders of carbohydrate metabolism, a standard glucose tolerance test is used. Particular attention in this regard is required by children from the danger group, which includes children born with a body weight of more than 4,500 g, children who have a history of diabetes burdened by diabetes, have pancreatic inflammation, are overweight, etc.

The clinical picture. The clinical manifestations of diabetes depend on the phase of the disease. The classification of diabetes mellitus was developed by M.I. Martynova. Manifest diabetes mellitus is characterized by the appearance of thirst, polyuria, night and day urinary incontinence, increased or, more rarely, decreased appetite, weight loss of a child, decreased performance, lethargy, academic performance, irritability. At this stage of diabetes, persistent hyperglycemia and glycosuria are detected. Most often, the initial period of the pathology (throughout the year) is characterized by a labile course and a relatively low need for insulin. After 10 months of treatment, a full compensation of the process may occur in 10-15 percent of children with no need for insulin or a very small daily requirement (up to 0.3 U / kg). By the end of the year of pathology, the need for insulin is growing, but in the subsequent process stabilizes.

The period of degenerative disorders is characterized by a high need for insulin, sometimes relative insulin resistance, especially in the prepubertal period, and in the presence of other diabetic effects (concomitant diseases, stressful conditions).

The position of clinical and metabolic compensation in diabetes mellitus is characterized by the absence of clinical signs of the disease and the normalization of metabolic processes: normoglycemia or glycemia no more than 7-8 mmol / l, daily glycemia fluctuations no more than 5 mmol / l, lack of glucosuria or slight excretion of sugar in the urine - not more than 5 percent of the sugar value of food. Clinical compensation is characterized by the absence of complaints and clinical signs of diabetes with continued metabolic disorders of carbohydrate and fat metabolism.

There is a milder degree of decompensation (without ketoacidosis) and ketoacidotic decompensation, which threatens the development of a diabetic coma in the absence of timely support for a sick child. The reasons for the development of diabetic coma can be different: late diagnosis of diabetes, violation of the diet, insulin therapy, the addition of intercurrent diseases and stressful situations.

The most typical clinical and metabolic variant of diabetic coma in children is the hyperketonemic (ketoacidotic) coma, the clinical manifestations of which are due to the development of deep metabolic acidosis, ketoacidosis, varying degrees of hyperglycemia and disturbed electrolyte balance with pronounced dehydration. For stage I coma, drowsiness, lethargy, weakness, increasing thirst, polyuria, decreased appetite, the appearance of nausea, vomiting, and the smell of acetone from the mouth are characteristic. Stage II is characterized by deeper impaired consciousness (soporous state), impaired cardiovascular function (decreased blood pressure, peripheral vascular tone, decreased glomerular filtration), polyuria, alternating with oliguria, vomiting, muscle hypotension, noisy, deep breathing, hyporeflexia. Stage III coma is characterized by a complete loss of consciousness, sharp violations of the cardiovascular system (cyanosis, vascular syncope, anuria, the occurrence of edema), the pathological nature of breathing, areflexia. Against the background of a coma, the development of a pseudo-abdominal symptom complex is likely. A hematorenal symptom complex may develop: high parameters of red blood, leukocytosis with a neutrophilic shift, the presence of protein, uniform elements and cylinders in the urine.

With diabetes in children, a hyperlactacidemic coma can be observed. A feature of the clinical manifestations of this option is an early onset of shortness of breath, accompanied by complaints of pain in the chest, behind the sternum, in the lumbar region and in the heart. A sharp decompensated metabolic acidosis and a relatively subfebrile degree of glycemia are characteristic.

A third option for diabetic coma in children may be a hyperosmolar coma, characterized by various neurological disorders: anxiety, high reflexes, cramping, and fever. Metabolic disorders are characterized by very high glycemia, an increase in serum sodium, an increase in the level of chlorides, total protein, residual nitrogen, urea, the absence of ketoacidosis, acidosis, and sharp dehydration.

The course of diabetes in children can be disrupted by the development of hypoglycemic conditions and hypoglycemic coma, the causes of which can be different: a violation of the diet, an excessive dose of insulin, excessive exercise. The hypoglycemic position is characterized by fatigue, anxiety, dizziness, sweating, pallor, muscle weakness, trembling hands, hunger, the appearance of high tendon reflexes. With the development of hypoglycemic coma, complete loss of consciousness, tonic-clonic spasms of choreoform and athetous movements, temporary mono- and hemiplegia are observed. In young children, an attack of hypoglycemia can be manifested by a sharp excitement, screaming, aggressive state, negativity. Hypoglycemia usually occurs when the blood sugar level drops below normal, although hypoglycemic conditions are likely to develop with a relatively high blood sugar level, but with a rapid decrease in high numbers.

Diagnosis . It is not difficult in the presence of clinical signs of the disease and laboratory data. Manifest diabetes must be differentiated from diabetes insipidus, thyrotoxicosis. During the development of diabetic coma, it is required to differentiate from about. appendicitis, meningitis, acetonemic vomiting. Hypoglycemic coma is differentiated from epilepsy.

Forecast . It is determined by the presence of vascular lesions.

Treatment . The main principles for the treatment of diabetes in children are diet therapy, the use of different insulin preparations and adherence to a diet. The daily caloric value of food is distributed as follows: for breakfast - 30%, for lunch - 40%, for afternoon tea - 10%, for dinner - 20%. Due to protein, 15-16% of calories are covered, due to fat - 25%, due to carbohydrates - 60%. The sugar value of food (100 percent carbohydrates, 50% protein) is taken into account, which is not required to exceed 380-400 g of carbohydrates per day. For the treatment of children, different insulin medications are used (Table 21). Recommended recommendation of courses of vitamin therapy, angioprotectors, choleretic and hepatotropic drugs

Treatment of diabetes in a child

The severity of diabetes in a child

Diabetes mellitus is also distinguished by severity.

Mild diabetes - fasting blood sugar levels are increased to 7.8–9 mmol / l, sugar in the urine may be absent or determined in minimal quantities - up to 1%. To this extent, diabetic ketoacidosis and coma still do not occur, there are no micro- and macro-vascular complications. Angiopathy (changes in the vessels of the retina of the eye) and initial kidney damage (nephropathy of the 1st to 2nd degree) may occur.

Moderate diabetes - blood sugar level up to 11-16 mmol / l, in urine - up to 2-4%, cases of ketoacidosis are already noted, i.e. diabetic coma. There are complications: diabetic retinopathy (sclerosis of the retina) of the 1st degree, nephropathy of the 3rd degree (microscopic amounts of protein appear in the urine), arthropathy, hyropathy (limiting the mobility of joints, mainly hands, occurs in 15-30% of adolescents with diabetes mellitus), angiopathy of the 2-3rd degree legs (narrowing of the small vessels of the legs), polyneuropathy of the extremities (neurological disorders - decreased sensitivity).

Severe diabetes - blood sugar levels fluctuate, may be higher than 16-17 mmol / l, metabolic disorders are expressed, there is an unstable course of diabetes mellitus - frequent ketoacidosis (presence of acetone in the urine), coma. Complications progress: diabetic retinopathy of the 2nd-3rd degree, nephropathy of the 4th (protein in the urine) or 5th degree with renal failure, neuropathy of various organs with severe pain, encephalopathy (dysfunction of the central nervous system), osteoarthropathy, chiropathy 2-3rd degree, macroangiopathy (narrowing of the larger vessels of the legs and arms), diabetic cataract, including with reduced vision, retarded physical and sexual development (Moriak and Nobekur syndromes).

Diabetes treatment is carried out for life and is a replacement therapy, i.e. compensates for the lack of the hormone insulin in the body, compensates for its absence or reduced production in the cells of the pancreas. Less commonly, in families where grandparents, uncles or aunts are ill with diabetes, the disease manifests itself in childhood or adolescence and occurs as type 2 diabetes. However, there are few such children and adolescents, approximately 4-5% of the total number of children with diabetes. In addition, obesity is a contributing factor in the development of type 2 diabetes. Some families have a cult of food. Parents make a lot of efforts to make the child eat more. Statistics show that more than 10% of high school students are obese or overweight. Most often, this obesity is a consequence of a hereditary predisposition, constitution and overeating. But any obesity is accompanied not only by a decrease in the physical stamina of the child and a decrease in its activity, but also a metabolic disorder, which results in diseases of the cardiovascular and digestive systems, and in obese children more often develop diabetes.

A life-threatening condition resulting from a sharp decrease in insulin is a diabetic coma. It is considered a complication of diabetes, and is provoked by an imbalance between blood sugar and ketone bodies. It is urgent to take measures to save the patient.

What triggers a diabetic coma?

Violation of the carbohydrate-alkaline balance can cause intoxication of the body, as well as the entire nervous system, resulting in a coma. As a result of this, ketone bodies begin to accumulate in the body, as well as acids (beta-hydroxybutyric and acetoacetic). Because of this, dehydration of the whole body occurs. Ketone bodies affect the respiratory center. The patient begins to experience lack of air, it is difficult to breathe.

Coma occurs due to impaired carbohydrate metabolism. With insufficient insulin production in the liver, a small amount of glycogen is formed, which leads to the accumulation of sugar in the bloodstream and poor cell nutrition. In the muscles, an intermediate product is formed in large quantities - lactic acid. Changes in carbohydrate metabolism leads to violations of all types of metabolism.

As glycogen becomes less in the liver, fat from the depot is mobilized. As a result of this, it does not completely burn out, and ketone bodies, acids, acetone begin to accumulate. The body loses a lot of vital trace elements. In this case, the concentration of salts in the liquids decreases, acidosis occurs.

Hyperglycemia

With elevated blood sugar levels, the patient may fall into one of the following lumps:

  • Hyperosmolar. It is characterized by metabolic disturbance, the amount of sugar increases, dehydration occurs at the cellular level. But, unlike other types of coma, a diabetic with a hyperosmolar coma will not smell of acetone from his mouth. This complication mainly develops in people who are more than 50 years old, but sometimes it occurs in children under 2 years old if the mother is sick with type 2 diabetes.
  • Lactacidemic. It appears as a result of anaerobic glycolysis, when glucose is not utilized, so the body wants to get energy for its life. So the processes begin to occur, leading to the formation of acidic decay elements that adversely affect the functioning of the heart and blood vessels. Signs of this condition are sudden severe vomiting, muscle pain, or apathy.
  • Hyperglycemic (ketoacidotic). Such a coma is provoked by the absence or poor treatment. The fact is that with an insufficient dose of insulin or its absence, the cells of the body do not absorb glucose, so the tissues begin to "starve". This triggers compression processes that break down fats. As a result of metabolism, fatty acids and ketone bodies appear, temporarily feeding brain cells. In the future, an accumulation of such bodies occurs, and as a result, ketoacidosis.

Hypoglycemia

A condition that occurs with a sharp decrease in blood sugar concentration. It is provoked by a lack of food or an overdose of insulin, and less often - hypoglycemic agents. Coma develops in a short period of time. A piece of sugar or a glucose tablet will help to avoid the bad effects.

Diabetes Precoma

Usually the patient does not immediately fall into a coma, this condition is preceded by precoma. This is a condition in which the patient experiences a number of unpleasant exacerbations due to disturbances in the central nervous system. The patient has:

  • lethargy,
  • indifference,
  • the appearance of a blush on the face,
  • narrowing of the pupils
  • confusion.

It is very important that at this time someone is with the patient and promptly calls for an ambulance so that the precoma does not turn into a coma.

Comatose signs of diabetes

Diabetic coma does not occur immediately. After a precomatous state, if no measures are taken, the patient’s situation worsens, the following symptoms are expressed:

  • feelings of weakness
  • drowsiness,
  • thirst,
  • headache,
  • nausea and vomiting,
  • low blood pressure
  • heart rate
  • lowering body temperature.

A person may lose consciousness, muscles and skin become relaxed. Blood pressure continues to drop.

The most striking sign by which you can determine the onset of coma is the presence of a smell of acetone from the mouth. A coma can be short-lived or last several hours, even days. If you do not take the necessary measures of help, then the patient will lose consciousness and die.

Another significant sign is the complete indifference to all events. Consciousness is dimmed, but sometimes enlightenment occurs. But at an extreme degree, consciousness can completely shut off.

What are the symptoms of coma in diabetes?

The doctor can diagnose the onset of diabetic coma by the following symptoms:

  • dry skin and itching,
  • sour breath
  • low blood pressure
  • very thirsty
  • general weakness.

If you do not take measures, then the situation of the patient is complicated:

  • vomiting becomes frequent, which does not bring relief,
  • worse abdominal pain
  • diarrhea occurs
  • the pressure drops
  • determined by tachycardia.

With hyperglycemic coma, the following symptoms appear:

  • feeling of weakness
  • constant desire to eat something,
  • sweating
  • trembling all over the body
  • anxiety and fear.

What awaits the patient after a diabetic coma?

The consequences of a diabetic coma can be identified by one phrase: the entire body is disrupted. This is due to the constant hunger of the cells, which is affected by an increased level of glucose in the blood.

Coma can be very long - from several hours to several weeks and even months. Its consequences are:

  • impaired coordination in movements,
  • incomprehensible speech
  • disturbances in the work of the heart, kidneys,
  • paralysis of the limbs.

It is very important to provide emergency medical care. If the ambulance arrives at the wrong time, cerebral edema occurs.

Diabetic coma in children

Often, young children are not always correctly diagnosed. The precomatous state is often mistaken for the presence of infection, meningitis, abdominal disease, acetonemic vomiting. Against this background, a coma arises, since the child receives a completely different treatment and assistance.

In children, different types of coma are distinguished. The most common ketoacidotic coma. Parents need to be attentive to their children, because this type of coma is not difficult to diagnose. Signs of the disease are:

  • constant desire to drink water,
  • frequent urination
  • decreased appetite
  • weight loss
  • dry skin.

Hyperlactatemic coma can occur in a child against the background of the fact that glucose breakdown occurs with insufficient oxygen, which leads to the accumulation of lactic acid. All these biochemical changes lead to the following symptoms:

  • the child becomes agitated, sometimes aggressive,
  • shortness of breath occurs
  • discomfort in the heart,
  • sore muscles in the arms and legs.

It is very difficult to determine this condition in young children, especially in infants, since there are no ketone bodies in the urine.

Emergency care for diabetic coma

Different types of coma can be prevented, and with a coma to alleviate the condition of the patient. To do this, you need to know about emergency care:

  • At ketoacidotic coma begin to administer insulin. Usually, small doses are administered intramuscularly at first, then they are transferred to large doses intravenously or dropwise. The patient is hospitalized in the intensive care unit.
  • At hypersmolar coma there is a simultaneous struggle with dehydration and high blood sugar. Therefore, sodium chloride is administered dropwise and insulin is administered intravenously or intramuscularly. Continuous monitoring of blood sugar and blood osmolarity is ongoing. The patient is placed in the intensive care unit.
  • At hyperlactacidemic coma sodium bicarbonate, also a mixture of insulin and glucose, is introduced to assist. If collapse is observed, then polyglucin and hydrocortisone are prescribed. They are hospitalized in the intensive care unit.

Diabetic Coma Treatment

With a diabetic coma, it is very important to start timely treatment. In this case, doctors can resort to the following measures:

  • Insulin is administered in small doses, intravenously. A blood test is taken from the patient every 2-3 hours for the determination of sugar and urine for the presence of sugar and acetone in it. If the effect is not observed, continue to be reintroduced and so on until the patient regains consciousness and all signs of coma disappear.
  • In order to prevent an overdose of insulin, the ketone bodies are burnt, glucose is injected an hour after insulin. These injections with glucose sometimes have to be done up to 5 times a day.
  • So that vascular collapse does not occur and to combat acidosis, saline with bicarbonate of soda is administered dropwise. After 2 hours, an intravenous injection with sodium chloride begins.
  • In order for oxidative processes to occur faster, the patient is allowed to inhale oxygen from the pillow. To the extremities apply heating pads.
  • To support the heart, injections containing caffeine and camphor are injected. The patient is prescribed vitamins: B1, B2, ascorbic acid.
  • After the patient emerges from a coma, he is prescribed sweet tea, compote, Borjomi. Gradually, the dose of insulin begins to decrease, administered every 4 hours. The patient’s diet is diversified with new products, the time intervals for taking drugs are increased.
  • Lyotropic substances are prescribed, which are contained in oat and rice porridge, low-fat cottage cheese and cod. It is necessary to limit the use of fatty foods. Then go to the initial dose of insulin.

Video: Diabetes coma and first aid

The expert will tell about the types, symptoms, causes, consequences of a diabetic coma:

The symptoms and first aid for hyperglycemia and hypoglycemia can be found in the video:

You must be careful in relation to a patient with diabetes. Take all types of treatment prescribed by your doctor, follow all instructions and recommendations, do not ignore them. Be sure to follow a diet. Prevent a coma and especially coma.

Diabetes mellitus is a dangerous disease of the endocrine system, accompanied by absolute or partial insufficiency in the human body of the hormone insulin (from Latin insula - an island) produced by the pancreas. The consequence of such a violation is a sharp increase in blood glucose levels (hyperglycemia), which leads to many life-threatening complications. Diabetic coma is one of the complications of diabetes, accompanied by a serious condition of a person, often causing death.

The pathogenesis of the disease is quite complex. The main reason for the development of coma in diabetes is a sharp increase in human blood sugar. This can be caused by a lack of insulin, improper medication, refusal to diet and some other provoking factors. Without insulin, the processing of glucose in the blood is impossible. As a result, an increase in glucose synthesis and an increase in ketone production begin in the liver. If the sugar level exceeds the number of ketones, the patient loses consciousness, a glycemic coma occurs.

Types of disease

Coma for diabetes has the following classification:

  • ketoacidotic - develops due to the accumulation of ketones in the body and their insufficient self-utilization. In medicine, this disease has a name - ketoacidosis,
  • hyperlactacidemic - a condition provoked by the accumulation in the body of lactate (a substance synthesized as a result of metabolic processes),
  • hyperosmolar - a special type of diabetic coma that occurs due to metabolic disorders in the body against diabetes mellitus,
  • hyperglycemic - occurs with a sharp increase in blood sugar,
  • hypoglycemic - a serious condition that develops against the background of a sharp drop in the patient’s blood sugar level.

Important! It is impossible to independently diagnose the type of diabetic coma. If complications develop, the patient should be taken to the hospital immediately.

Signs of different types of diabetic coma are similar and it is possible to diagnose a specific type of coma exclusively with the help of laboratory research methods.

You can find out more about the symptoms of diabetic coma.

Common manifestations of a precomatous state include weakness, headaches, thirst, hunger, and other manifestations

Common symptoms of diabetic coma

Common signs of diabetes complication are:

  • feeling of thirst
  • frequent urination
  • fatigue, weakness, poor health,
  • persistent or paroxysmal headache
  • drowsiness or, conversely, nervous excitement,
  • loss of appetite
  • visual impairment, glaucoma sometimes occurs,
  • nausea, dizziness, vomiting.

In the absence of proper treatment, the patient has a pathological condition, referred to in medical practice as a true coma.

True coma

True coma in diabetes is the condition of the patient, accompanied by the following symptoms:

  • indifferent to people around and events,
  • confusion of consciousness with moments of enlightenment,
  • in severe cases, there is completely no reaction to external stimuli.

During an external examination, the doctor discovers a number of characteristic symptoms:

  • dry skin,
  • with hyperglycemic or ketoacidotic coma, the smell of acetone from the patient’s oral cavity is felt,
  • a sharp drop in blood pressure,
  • fever
  • softness of the eyeballs.

This condition requires urgent medical attention, often provokes a fatal outcome.

Signs of hyperglycemic coma

In patients with this type of complication, the following symptoms occur:

  • a sharp increase in hunger,
  • trembling in the body
  • malaise, weakness, fatigue,
  • increased sweating
  • increased anxiety, the development of feelings of fear.

If within a few minutes a person with this condition does not eat something sweet, there is a risk of loss of consciousness, the appearance of seizures. The patient's skin becomes wet, eyes are soft.


Hyperglycemic coma is the most common type of complication of diabetes, accompanied by many negative manifestations

Manifestations of hypersmolar coma

Diabetic coma of this type develops relatively slowly, from several hours to several days. In this case, the following manifestations occur:

  • the development of dehydration,
  • general malaise
  • neuralgic abnormalities
  • sudden movements of eyeballs, of an involuntary nature,
  • the appearance of seizures,
  • difficulty speaking
  • decreased urine output.

Important! Hypersmolar coma is rare, diagnosed mainly in elderly patients.

Symptoms of hypoglycemic coma

The clinic of hypoglycemic coma is often oiled. It develops gradually, accompanied by a slow deterioration in well-being.

  • headache that is not amenable to medication,
  • cold hands and feet
  • increased sweating
  • weakness,
  • the appearance of hunger,
  • fainting condition
  • feeling of heat
  • pallor of the dermis,
  • shortness of breath when walking, intermittent breathing.

The patient becomes irritable, loses his ability to work, and quickly becomes tired. With a complex course, a person experiences double vision, nausea, trembling in the arms and legs, later in all other muscles of the body. These symptoms are often called precoma (precomatose state).

Important! When the above symptoms appear, going to the hospital should be immediate. Every minute of delay can cost a person life.

Features of diabetic coma in children

In childhood, this type of complication develops under the influence of many provoking factors. The reasons include excessive consumption of sweets, physical injuries, decreased metabolic processes, a sedentary lifestyle, improper dosage of insulin-containing drugs, poor-quality medications, late diagnosis of the disease.


Symptoms of an attack in children are difficult to go unnoticed, anxiety, impaired appetite and general condition develop

The precursors of an attack include the following manifestations:

  • the baby complains of a headache
  • anxiety develops, activity gives way to apathy,
  • the child has no appetite,
  • nausea often accompanied by vomiting
  • there are pains in the stomach
  • integuments acquire a pale shade, their elasticity is lost.

In severe situations, convulsions develop, there is an admixture of blood in the feces, eyeballs sink, blood pressure and body temperature decrease.

Among the complications in children are dehydration, the development of severe pathologies of internal organs, pulmonary and cerebral edema, the occurrence of renal failure, shortness of breath, and fatal outcome.

Diagnostics

Diagnosis of diabetic coma in diabetes is carried out using a laboratory study of the patient’s blood. In order to make a diagnosis, the patient is prescribed the following types of tests:

  • general blood analysis,
  • blood chemistry,
  • biochemical analysis of urine.

Test scores vary depending on the type of coma. With a ketoacidotic coma, an increase in the urine of ketone bodies is noted. Hyperglycemic coma is accompanied by an increase in blood glucose by more than 33 mmol / liter. With hyperosmolar coma, an increase in the osmolarity of blood plasma is diagnosed. Hypoglycemic coma is characterized by low blood glucose, less than 1.5 mmol / liter.

First aid

With the development of diabetic coma in children and adults, it is necessary to provide the patient with competent first aid. If a person is unconscious, you must perform the following steps:

  1. Call an ambulance crew.
  2. In the absence of a pulse and breathing, it is necessary to start an indirect heart massage and make artificial respiration. During this period, it is necessary to monitor the cleanliness of the respiratory tract.
  3. If the pulse is heard, breathing is maintained, you need to provide access to fresh air, free a person from tight clothing, unfasten the collar.
  4. The patient should be put on his left side, in case of vomiting, it is important to ensure that he does not choke.


The life and health of the patient depends on the literacy of emergency care for the development of an attack

During emergency care, a conscious, diabetic coma should be given to drink. If it is known that a serious condition is caused by a decrease in glucose in the blood, the patient should be given food or water containing sugar.

Learn more about first aid for a diabetic coma.

Effects

A diabetic coma is a serious condition that lasts from several hours to several weeks and even months. Among the consequences, there is a violation of coordination of movements, cardiovascular diseases, pathologies of the kidneys, liver, difficulty speaking, paralysis of the extremities, loss of vision, swelling of the brain, lungs, respiratory failure, death.

Therapeutic measures

To prevent negative consequences, it is important to begin timely treatment of complications. In this case, the patient is injected with insulin injections after certain periods of time. At the same time, blood sampling is done to determine the presence of sugar and acetone in it. In the absence of effect, glucose is re-administered until the blood biochemical parameters are normalized.

To neutralize ketone bodies, glucose is administered one hour after insulin injection. About five can be performed per day of such operations.

The introduction of saline with bicarbonate of soda helps prevent vascular collapse. After a few hours, sodium chloride is administered intravenously.


Treatment of an attack in diabetes mellitus is aimed at removing the patient from a coma, normalizing the biochemical parameters of blood

During therapy, the patient inhales oxygen from the pillow, a heating pad is applied to the lower extremities. This provides increased metabolic processes.
To maintain cardiac activity, the patient is given injections with caffeine, vitamins B 1 and B 2, ascorbic acid.

After the patient emerged from a coma, rehabilitation is as follows:

  • gradual decrease in the dose of insulin,
  • an increase in the interval between taking medications,
  • purpose of sweet tea, compote,
  • the exception of fatty, spicy, salty, sour, fried foods,
  • the basis of the diet is cereals, vegetables, fruits, dairy products.

Important! Non-compliance with the rules of rehabilitation and refusal of treatment can lead to the development of a second attack.

Prognosis for the patient

Diabetic coma is one of the common and dangerous complications of diabetes. The condition requires emergency medical attention, proper treatment, compliance with preventive measures aimed at preventing complications. The prognosis for the patient is favorable only in case of timely admission to the hospital. At the same time, it is possible to normalize the patient's condition and prevent the severe consequences of coma.

On Earth, there are over 422 million people diagnosed with diabetes. These people need constant use of hypoglycemic drugs, but due to the current level of development of medicine, maintaining a satisfactory quality of life is achievable. The most dangerous consequence of diabetes is a diabetic coma, an emergency condition requiring immediate hospitalization.

What is a diabetic coma

Sugar coma is a profound impairment of consciousness that occurs in diabetics. Insulin deficiency or insulin resistance results in a deficiency of glucose in the tissues and accumulation of blood sugar. The answer to this is the synthesis of glucose by the liver from acetyl coenzyme A. By-products of synthesis along this metabolic pathway are ketone bodies. As a result of the accumulation of ketone bodies in the blood, a shift in the acid-base and electrolyte balance occurs, which leads to the occurrence of severe impaired consciousness.

Varieties

With diabetes, the following types of coma are found:

  1. Ketoacidotic variant: for type I diabetes.
  2. Hyperosmolar coma: in the case of a sharp increase in sugar in type II diabetes.
  3. Lactacidemic coma - in diabetics with concomitant pathologies of the cardiovascular system, liver, kidneys, anemia, alcohol poisoning, salicylates, shock.
  4. Hypoglycemic coma: if the dose of insulin does not match the glucose level.

In diabetes mellitus, coma develops with the following blood glucose concentrations: above 33 mmol / L for acidotic variants, 55 mmol / L for hyperosmolar, below 1.65 for hypoglycemic.

  • improper treatment regimen
  • errors in taking drugs,
  • reduced physical activity
  • eating disorders
  • acute complications of diabetes caused by other diseases (infectious, endocrine, mental, disorders of the nervous system, etc.),
  • stress
  • pregnancy.

In its development, coma with diabetes passes through four stages, characteristic of all coma:

  1. Already the first degree of coma is characterized by a lack of consciousness. The body's reflexes are reduced, but the reaction to pain is preserved.
  2. Second degree: impaired consciousness progresses, all kinds of sensitivity are lost. Involuntary urination, bowel movement are observed. Abnormal breathing occurs.
  3. Third degree: respiratory distress becomes gross. Muscle tone is absent. Disorders from various body systems join.
  4. Fourth degree: transition to a pre-state.

Characteristic signs of diabetic coma with hyperglycemia:

  • severe dehydration,
  • the smell of acetone coming from the patient (absent with hyperosmolar coma),
  • reduced ophthalmotonus,
  • Kussmaul pathological breathing (absent with hyperosmolar coma).

Signs of hypoglycemic coma:

  • skin moisture
  • increase in intraocular pressure - hard eyeballs (a symptom of a "stone eye"),
  • pupil expansion
  • normal or fever
  • high rate of progression of symptoms.

With acidotic forms of coma, the body tries to compensate for hyperacidosis by developing respiratory alkalosis using hyperventilation: breathing quickens, it becomes superficial. Further progression of acidosis leads to the appearance of Kussmaul respiration, which is characterized by:

  • significant depth of breath
  • difficulty exhaling
  • lengthening the pause between breaths.

Diabetic precoma

Coma in diabetes mellitus develops gradually: from a few hours to several days can pass to a loss of consciousness. An exception is the hypoglycemic form. Coma is preceded by a worsening condition - a diabetic crisis. Its signs are:

  • symptoms of endogenous intoxication: headaches, fatigue, nausea, vomiting, weakness,
  • itchy skin
  • dry mouth and thirst
  • increased urination.

In the second stage of precoma, patients fall into a stupor, breathing changes occur, pseudoperitonitis syndrome (abdominal pain, tension of the abdominal muscles, symptoms of peritoneal irritation), dehydration symptoms: dry skin and mucous membranes, decreased blood pressure can occur. Hypoglycemia is characterized by muscle hypertonicity, high tendon reflexes, and profuse sweating.

Watch the video: "Management of Diabetic Ketoacidosis" by Michael Agus, MD for OPENPediatrics (March 2020).