Diagnosis and Management of Diabetic Coma
I would like to ask the doctor, if a diabetic patient falls into a coma, how can we diagnose that the coma is caused by diabetes and what treatment measures should be taken?
Doctor's answer (1)
Diabetic coma is a severe manifestation of acute diabetic complications, mainly including hyperosmolar nonketotic diabetic coma and hypoglycemic coma. During diagnosis, a detailed medical history should be obtained to understand the patient's glycemic control status, recent diet, medication use, and presence of stress conditions such as infection or surgery. Physical examination should focus on the patient's level of consciousness, degree of dehydration, and whether there is a ketotic odor in the breath. Additionally, monitor whether the patient exhibits persistently elevated blood glucose levels, typically exceeding 33.3 mmol/L, accompanied by symptoms such as thirst, polyuria, nausea, and vomiting.
In terms of management, prompt measures must be taken. Insulin therapy should be used to lower blood glucose levels, with dosage adjustments based on blood glucose monitoring. Fluid replacement therapy should then be administered to replenish fluid loss, prevent dehydration and electrolyte disturbances. Electrolyte imbalances should also be corrected to restore normal nerve conduction and muscle contraction function. Simultaneously, blood glucose levels should be controlled to prevent central nervous system damage caused by hyperglycemia, and respiratory function should be maintained to prevent the risk of respiratory failure.
