How Can a Diabetic Coma Be Managed?
The two causes of diabetic coma, hyperosmolar hyperglycemic state (HHS) and diabetic ketoacidosis (DKA), differ in whether or not there is ketoacidosis. Although both have severe hyperglycemia, that of HHS is more severe.
The results of metabolic changes in both lead to abnormalities in electrolyte concentrations, which can be life-threatening. Identifying the cause of the diabetic coma and determining the severity of the electrolyte abnormalities can then guide treatment.
The approach to treating either cause is similar and includes the following:
- Infusion of fluids to dilute the over-concentration in the blood from the hyperglycemia, replenish the volume of fluids lost, and improve blood pressure and perfusion of organs to stabilize the cardiovascular status.
- Correct the potassium deficiency, which will recur after giving insulin
- Insulin administration in low IV doses so that any hypokalemia can be anticipated and corrected
- Monitor serum glucose, sodium, potassium, and vital signs frequently
- Determine cardiac status via EKG
When the cause is ketoacidosis, treatment includes:
- IV sodium bicarbonate to counteract a pH <6.9. Frequent monitoring of the arterial blood gases is necessary for status of the pH and bicarbonate levels