Monday, July 16, 2012

Non-Ketotic Hyperosmolar Coma in Diabetics

Non-Ketotic Hyperosmolar Coma in Diabetics

This coma is associated with nursing home patients but can occur in all ages. The principal symptom is lethargy that progresses to behavior that mimics one with less than  normal mental capacity. Vomiting is not, ordinarily, associated with this type of coma.

Extreme hyperglycemia is accompanied by dehydration when the person doesn't drink enough fluids. This coma occurs most often in people who develop Type II diabetes and they have an impaired ability to recognize when they are thirsty. They need to drink and, instead, slip into a state of dehydration from lack of fluids.

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When the person exhibits mental confusion that is not characteristic, the physician may order a chemical screen. The screen, with this type of coma, may show extreme hyperglycemia ( 1800 mg/dl - 100 mM) and dehydration. 

Treatment consists of insulin and gradual rehydration with intravenous fluids.