Hyperosmolar diabetic coma in children: causes, symptoms, diagnosis, treatment
Last reviewed: 23.04.2024
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Hyperosmolar diabetic coma is a coma that is characterized by hyperglycemia above 50 mmol / l and lack of ketosis.
Causes of hyperosmolar coma
This variant of coma develops in conditions accompanied by dehydration: vomiting, diarrhea, the presence of diabetes insipidus, and the like. The factors that aggravate insulin deficiency include intercurrent diseases, surgical interventions, cimetidine, corticosteroids, catecholamines, beta adrenoblockers, furosemide, mannitol, thiazide diuretics, slow calcium channel blockers.
Symptoms of hyperosmolar diabetic coma
Hyperosmolar coma develops more slowly than diabetic ketoacidosis. It is characterized by hyperthermia, pronounced exsicosis in the absence of acidosis, early appearance of neurological disorders (aphasia, hallucinations, convulsions).
Criteria for diagnosis
The level of glycemia is 50-100 mmol / l, hypernatremia. The level of ketone bodies in urine and blood is normal or slightly elevated. Osmolality of plasma 330-500 mOsm / kg; blood pH 7.38-7.45; BE +/- 2 mmol / l.
Emergency medical events
Initially rehydration is carried out with the help of 0.45% sodium chloride solution: children under the age of 1000 ml are administered, at the age of 1-5 years - 1000-1500 ml, 5-10 years - 2000 ml, adolescents 10-15 years - 2000-3000 ml. When the osmolarity of the blood decreases below 320 mOsm / l, the introduction of a 0.9% solution of sodium chloride occurs. With a decrease in glycemia below 13.5 mmol / l, a 5-10% solution of glucose is prescribed. In the first 6 hours, you must enter 50% of the daily amount of fluid, the next 6 hours - 25% and the remaining 12 hours - the remaining 25%.
The starting dose of insulin, despite the high glycemia, should not exceed 0.05 U / kghh), because patients are highly sensitive to insulin, and with a rapid decrease in glucose, cerebral edema can occur. Enter heparin sodium, vitamins B and C, antibiotics of a wide range of action.
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