Hyperosmolar diabetic coma in children: causes, symptoms, diagnosis, treatment

Hyperosmolar diabetic coma is a comatose state characterized by hyperglycemia above 50 mmol/l and the absence of ketosis.

Causes of hyperosmolar coma

This type of coma develops in conditions accompanied by dehydration: vomiting, diarrhea, diabetes insipidus, etc. Factors that aggravate insulin deficiency include intercurrent diseases, surgical interventions, taking cimetidine, corticosteroids, catecholamines, beta-blockers, furosemide, mannitol, thiazide diuretics, calcium channel blockers.

Symptoms of hyperosmolar diabetic coma

Hyperosmolar coma develops more slowly than diabetic ketoacidosis. It is characterized by hyperthermia, severe exsicosis in the absence of acidosis, and early onset of neurological disorders (aphasia, hallucinations, seizures).

Diagnosis criteria

Glycemia level is 50-100 mmol/l, hypernatremia. The level of ketone bodies in urine and blood is normal or slightly increased. Plasma osmolality is 330-500 mOsm/kg; blood pH is 7.38-7.45; BE +/- 2 mmol/l.

Emergency medical measures

Initially, rehydration is carried out using a 0.45% sodium chloride solution: children under one year old are given up to 1000 ml, 1000-1500 ml at the age of 1-5 years, 2000 ml at the age of 5-10 years, and 2000-3000 ml at the age of 10-15 years. If blood osmolarity decreases below 320 mOsm/l, a transition is made to the administration of a 0.9% sodium chloride solution. If glycemia decreases below 13.5 mmol/l, a 5-10% glucose solution is prescribed. In the first 6 hours, 50% of the daily amount of fluid must be administered, in the next 6 hours - 25%, and in the remaining 12 hours - the remaining 25%.

The starting dose of insulin, despite high glycemia, should not exceed 0.05 U/kg h), since patients are highly sensitive to insulin, and with a rapid decrease in glucose, cerebral edema may occur. Sodium heparin, vitamins B and C, and broad-spectrum antibiotics are administered.

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