MHET 2134
HYPERGLYCEMIA COMA
Bryan Junior , DPMH1/2022(14)-0004
Content outline
• Definition of hyperglycemia coma
• Etiology of hyperglycemia coma
• Pathophysiology
• Clinical manifestation
• Investigation
• Differential diagnosis
• Emergency management
• Complications
• Prognosis
Definition
A hyperglycemia coma is a severe medical condition that
occurs when blood sugar levels become extremely high and
lead to state of unconsciousness. There are two primary
types of hyperglycemic coma :
a) Diabetic Ketoacidosis (DKA)
b) Hyperosmolar Hyperglycemic State (HHS)
Definition
q Diabetic Ketoacidosis (DKA) : a serious and potentially life-
threatening complication of diabetes, most commonly associated
with type 1 diabetes but also occurring in type 2 diabetes. It arises
when the body starts breaking down fats at an excessively high
rate, producing ketones, which are acidic by products of fat
metabolism.
Definition
o Hyperosmolar Hyperglycemic State (HHS) : also known as
Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS), is
refer to severe persistent hyperglycemia, in the absence of ketosis
and accompanied by profound dehydration. It is more common in
diabetes Type 2 .
Etiology
Diabetic Ketoacidosis (DKA)
• Insulin Deficiency ( missed insulin dose ),DM Type 1
• Infection or illness
• Stress
• Medication (Corticosteroids , diuretics)
• Substance abuse (Alcohol abuse)
Etiology
Hyperosmolar Hyperglycemic State (HHS)
• Insulin deficiency ( DM Type 2)
• Infection (UTI)
• Medication (Diuretics)
• Medical condition : Heart failure , recent strokes
Pathophysiology
Diabetic Ketoacidosis (DKA)
• The lack of insulin leads to an inability to use glucose for
energy.
• The body compensates by breaking down fats into
ketones, resulting in metabolic acidosis.
• This acidosis, combined with hyperglycemia and
dehydration, leads to the symptoms of DKA.
Pathophysiology
Hyperosmolar Hyperglycemic State
• The extreme hyperglycemia can lead to raising of the
serum osmolality.
• High serum osmolality causes osmotic diuresis , leading
to dehydration.
• Dehydration is significant of fluid and electrolyte loss.
• These hyperosmolarity can lead to neurological symptom
due to dehydration includes altered mental status,
seizures and coma.
Clinical Manifestation
• Polydipsia (increase thirst)
• Polyuria
• Abdominal pain (DKA)
• Weight loss
• Altered counscious state
• Kussmaul breathing (DKA)
• Ketotic breath (DKA)
• Dehydration (poor skin turgor, tachycardia, hypotension, dry
mouth)
Investigations
• Blood glucose level
• Arterial Blood Gas (ABG)
• Serum ketones
• Blood Urea Serum Electrolyte (BUSE) and creatinine
• Urinalysis
• Full blood count
• Renal function test
• Liver function test
• Blood culture and sensitivity
• HbA1c
• Electrocardiogram (ECG)
Differential diagnosis
• Diabetic ketoacidosis (DKA)
• Hyperosmolar Hyperglycemic State (HHS)
• Undiagnosed DM
• Lactic acidosis
Management
Assestment
• History and physical examination :
- Look for precipitating causes: infection, missed therapy, non-
adherence, acute coronary syndrome, cerebrovascular accident,
surgery and drugs (e.g. steroids) .
- Do investigations towards patient .
Management
Principle of management
• Correction of dehydration
• Correction of electrolyte imbalance
• Insulin therapy
• Treatment of precipitating factor
• Prevention of the complications
Emergency Management
Emergency Management
Monitoring
• Hourly capillary plasma glucose until reach 9-12 mmol/L
• Vital sign and input-output charting hourly
• 6-hourly BUSE and blood/urine ketones
• If ketones and glucose are not falling as expected, check if the insulin
infusion pump is working and connected, and the correct insulin residual
volume is present
• If equipment is working but response to treatment inadequate, increase
insulin infusion rate by 1 U/hr increments hourly until targets are achieved.
Emergency Management
Emergency Management
• Recognition of pseudohyponatraemia in severe hyperglycaemia is important
as to avoid using hypertonic saline.
• In the presence of heart failure and renal failure, cautious fluid replacement is
advised
Complications
• Severe dehydration
• Cerebral edema
• Acute myocardial infarction
• Altered mental status
Prognosis
Prognosis of hyperglycemic coma is depends on several factors ,
which including the cause which is diabetic ketoacidosis (DKA) or
hyperosmolar hyperglycemic state (HHS) . speed and adequacy of
t r e a t m e n t , p a t i e n t ’s o v e r a l l h e a l t h a n d p r e s e n c e o f a n y
complications. The prognosis can be good if there is early detection
and early treatment.
THANK YOU
[Link]
020_13042021.pdf
