Hypoglycemic coma - a condition caused by a decrease in blood glucose levels below 2.8 mmol / l (in newborns below 2.2 mmol / l).
Causes of hypoglycemic coma
First of all, hypoglycemia arises in connection with an overdose of insulin, against the background of physical stress and diet disorders. Diseases of the liver and kidneys, as well as alcohol, contribute to its development. Hypoglycemia in newborns is observed with prematurity, intrauterine growth retardation, hypoxia, asphyxia, hypothermia, sepsis, congenital heart disease. This problem can occur in children with a deficiency of glucagon, with type I glycogenosis, galactosemia. Intolerance to fructose, with adrenal insufficiency. The following factors are also important: diabetes maternal, hemolytic disease, exchange blood transfusions, hyperplasia or adenoma of pancreatic islet cells, leucine intolerance, maternal treatment with chlorpromide or benzothiadiazides. It is necessary to consider the possibility of insuloma.
Symptoms of hypoglycemic coma
Children suddenly become indifferent to what is happening, sluggish, sleepy. There is a feeling of hunger, headache, dizziness, rapidly changing eyes. Possible unmotivated reactions: crying, euphoria, aggressiveness, autism, negativism. In the absence of timely assistance, consciousness is obscured, trisus, myoclonus, and / or generalized convulsions occur.
Criteria for diagnosis
"Sudden" loss of consciousness against the background of a satisfactory state of health of a child suffering from diabetes. There are no dehydration phenomena. Respiration is even, pulse of satisfactory filling, blood pressure is normal or with a tendency to increase. Pupils are wide, their reaction to light is preserved. Tendon reflexes are alive. The study of glycemia confirms the diagnosis.
Emergency medical events
Having established the diagnosis, it is necessary to inject 40% glucose solution (2 ml / kg, not exceeding the total dose of 5 ml / kg) immediately before intravenous bolus until complete recovery of consciousness. If necessary, infusions are carried out in a decreasing concentration of a glucose solution of 20-10-5%, in addition, dexamethasone or methylprednisolone is administered. Glucagon - intramuscularly or subcutaneously 0.02 mg / kg.
It is admissible to administer epinephrine 10 μg / kg. With the duration of a coma for several hours, it is necessary to introduce a 25% solution of magnesium sulfate in a dose of 0.1-0.2 ml / kg. In the case of insuloma, insulin secretion inhibitors are prescribed: diazoxide (hyperstat), octreotide (sandostatin), in the diagnosis of neoplasm - streptozocin (zanosar).
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