Part 8. Paraclinical evidence and treatment principles of hyperglycemic coma without ketoacidosis

(Baonghean) - Ladies and gentlemen, on Tuesday (January 29, 2013) we are talking to you about the clinical symptoms of Non-Ketoacidotic Hyperglycemic Coma. Today, we continue to talk about the paraclinical evidence (CLS) and the principles of treatment of this complication.

Non-ketoglycemic hyperglycemic coma, also known as hyperosmolar coma, has the following subclinical symptoms:

First: Osmotic pressure increases > 320 mosm/l. How to calculate osmotic pressure:

ALTT = 2(Na+K) + Urea + Glucose (mmol).

Second: Blood sugar increases 25 - 30 mmol/l or more.
3rd: Hypernatremia.
Wednesday: Hypokalemia, possibly hypophosphatemia.
Thursday: Normal blood pH, normal alkaline reserve.
Friday: Increased blood urea and creatinine.

When diagnosed with Hyperosmolar Coma, it must be treated promptly according to the following principles:

● First aid treatment:

- Fluid must be given to compensate for water loss, based on central venous pressure (can be up to 10 liters/day).

+ The amount of fluid to be infused can be determined by calculating the actual Na+ ==> refer to the following formula:

A = Na+ + (1.6(G – ​​5.5)/5.5)
D = 0.6 x P x A/140

In there:

A: is the actual amount of Na+;
Na+: is the amount of sodium measured in the patient's plasma.
D: is the amount of fluid needed to be added (liters).
P: is body weight (Kg).
G: is the amount of plasma glucose in mmol/l

Note:This is a way to calculate the amount of fluid that needs to be replaced for the body that has been lost over a long period of time. However, how to compensate depends on the actual situation of the patient to have appropriate indications. It is best to rely on the central venous pressure to adjust the amount of fluid infused.

+ The type of infusion is isotonic 0.9% NaCl solution, Ringer lactate can be infused. If the patient has congestive heart failure, use hypotonic 4.5‰ NaCl solution.

+ 5% glucose can be used to avoid the risk of hypoglycemia (when blood glucose drops to 12 mmol/l)

- Use insulinRapidly lower blood sugar (preferably intravenously) as part of the treatment regimen for ketoacidosis

- Supplement potassium with insulin at a dose of 10 - 20 ml of 10% KCl and 4.5% NaCl.

Note: Monitor fluid intake and output, blood sugar, osmotic pressure to adjust insulin dose hourly until the patient's blood sugar and osmotic pressure return to normal and the patient is fully awake.

● Then treat:

- Treatment of heart failure (if any), can give Uabain or Digoxin.
- Give antibiotics to prevent secondary infection.
- Treat the cause of the disease.
- Anticoagulants: Unlike people in ketoacidosis coma, people in hyperosmolar coma have a much higher risk of embolism, so the use of anticoagulants is really necessary.

Note:In the treatment of hyperosmolar coma, correction of fluid and electrolyte disturbances is very important. Because blood sugar can return to normal when adequate fluid and electrolyte replacement is given.

Doctor Nguyen Van Hoan (Director of Nghe An Endocrinology Hospital)