Part 10: Acute complications of diabetes: Coma due to Lactic Acidosis.
1. Clinical signs:
The onset is often sudden, coma occurs very quickly, after a few hours. Symptoms include:
- Vomiting, pale skin, impaired consciousness, drowsiness.
- Body temperature drops, blood pressure drops, cardiovascular collapse.
- Kussmaul breathing.
- Oliguria or anuria.
2. Paraclinical signs:
- Moderate increase in blood sugar.
- Increased lactic acid (normal lactic acid 0.56 - 2.2 mmol/l).
- Alkaline reserves decrease, blood pH decreases.
- K+ increases in renal failure.
- Increased white blood cells.
3. Treatment.
- Treat the cause of lactic acidosis.
- Good ventilation, restore blood pressure and prevent cardiovascular collapse.
=> Anti-acidification of blood:
Nabica is administered in the following doses:
HC03 = (25 mỌq/l HC03 - measured HC03) x 0.5 (weight in kg).
=> Rapid insulin infusion is similar to the dose used to treat ketoacidosis coma.
=> Treat heart failure with ouabain or digoxin. If blood pressure drops, raise blood pressure with drugs (dopamine, dobutrex).
=> Replenish water and electrolytes by infusing THM solution 9‰, ringerlactate or 5% glucose.
=> If there is kidney failure: Hemodialysis or peritoneal dialysis.
Doctor Nguyen Van Hoan (Director of Provincial Endocrinology Hospital)
