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Hyperosmolar coma: Treatment, symptoms, advice and help

About hyperosmolar coma

Hyperosmolar coma also called ‘hyperglycaemic hyperosmolar syndrome’ is a potentially life-threatening complication of type 2 diabetes mellitus in which there are very high blood sugar levels without the presence of acidic ketone bodies. It presents as altered consciousness and dehydration.

Hyperosmolar coma: Incidence, age and sex

Hyperosmolar coma occurs predominantly in patients with type 2 diabetes. However it may also occur in type 1 diabetes, under certain circumstances. Old age individuals who have diabetes are especially prone to hyperosmolar coma.

Signs and symptoms of hyperosmolar coma: Diagnosis

The symptoms of hyperosmolar coma usually evolve rapidly over one or two days and consist of excessive thirst and decreased urine output. In severe cases, there may be mental confusion, lethargy, increased heart rate, low blood pressure and coma. Other features of dehydration like dryness of the mouth, sunken eyes, dry and pinched skin may also be manifested.

Various blood tests like blood sugar, serum osmolarity, blood urea and creatinine may be advised to detect the condition. Urine tests may also be done to corroborate the diagnosis.

Causes and prevention of hyperosmolar coma

Hyperosmolar coma is seen in individuals with type 2 diabetes as a result of poor control of diabetes or other precipitating factors. Such precipitating factors include an infection, serious illness, recent surgery, old age, heart attack or stroke. Missing the diabetes medications (oral hypoglycaemic drugs or insulin dose) may also result in hyperosmolar coma.

Episodes of hyperosmolar can be prevented by proper diabetes education which include adherence to “sick day guidelines”. These guidelines tell patients how to treat themselves when unwell. Moreover, it is essential to manage diabetes properly and keep the blood sugar levels in control.

Hyperosmolar coma: Complications

If untreated, hyperosmolar coma can rapidly lead to circulatory shock, formation of blood clot or increased blood acid levels, respiratory failure and even death.

Hyperosmolar coma: Treatment

Hyperosmolar coma is a medical emergency and affected individuals require immediate hospitalization and intensive management. Large amount of intravenous fluids are needed to correct dehydration. Intravenous insulin infusion is necessary to bring blood sugar level to normal. Frequent monitoring and appropriate correction of electrolyte levels in blood (mainly potassium) is needed. If there is respiratory failure, the individual may require artificial ventilation. There are increased chances of mortality if the individual is not managed with urgency.