Hyperosmolar non ketosis diabetic coma
Hyperosmolar non ketosis diabetic coma is another acute disease of diabetes. Hyperosmolar coma is commonly seen in elderly patients. About 2/3 cases had no history of diabetes or mild symptoms before onset. There are often obvious inducements, such as infection, acute gastroenteritis, cerebrovascular accident, serious kidney disease, hemodialysis or peritoneal dialysis treatment, some drugs (such as glucocorticoids and immunosuppressants), misdiagnosis of glucose input or oral administration of a large amount of orange syrup, which induce or promote the deterioration of the disease. In patients with diabetes mellitus, family history of diabetes or without diabetes, there are signs of signs when there is a disturbance of consciousness, especially in the elderly. Hyperosmolar non ketonic diabetic coma in the elderly has four characteristics: hyperglycemia, high plasma osmotic pressure, lack of obvious ketosis and progressive loss of consciousness. There are often clear predisposing factors (1) the most common are infection, cerebrovascular accident, acute myocardial infarction and other stress states. Increase the secretion of anti insulin hormones such as growth hormone, glucagon and cortisol. (2) excessive intake of sugar or inappropriate supplement of glucose. (3) decreased renal function, gastrointestinal dysfunction with vomiting, no eating, aggravating dehydration and hypertonic state, etc. (4) for suspected hyperosmolar non ketosis diabetic coma patients, blood should be taken immediately to check blood sugar, blood electrolytes (Na +, K +, Cl -) urea nitrogen, creatinine and CO2cp. Conditional ketones, blood gas analysis, urine glucose and ketone bodies were taken for electrocardiogram. (5) laboratory diagnostic criteria for hyperosmolar non ketonic diabetic coma in the elderly: blood glucose is more than 33.3mmol/L (600mg/dl); Blood sodium > 145mmol / L; Plasma osmotic pressure ≥ 350mmol / L or effective osmotic pressure > 320mmol / L; Urine sugar was strongly positive, urine ketone body was negative or weakly positive.
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