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My Friend Was Rushed To The ER In A Coma
Question: My friend was rushed to the ER in a coma. Her skin was flushed and moist. They said her respiration’s were slow. I’m waiting for her diagnosis now. Her vitals when she arrived were heart rate:75bpm, blood pressure 112/87, respiratory rate 10tpm and oxygen 100%. What got her here was she took her insulin twice last night.
Do you know what may be wrong with her? Or what may be her diagnosis?
Do you know what may be wrong with her? Or what may be her diagnosis?
Brief Answer:
Get her Blood Glucose level checked right away, infuse 10% Dextrose
Detailed Answer:
Hello,
Your friend is in hypoglycemic coma due to taking double dose of insulin.
Her other vitals are stable and she is in coma due to low blood sugar level.
Check her blood glucose level using a Glucometer right away and ask the doctor to start her on 10% dextrose infusion without delay.
She will recover in no time.
Hope that helps.
Get her Blood Glucose level checked right away, infuse 10% Dextrose
Detailed Answer:
Hello,
Your friend is in hypoglycemic coma due to taking double dose of insulin.
Her other vitals are stable and she is in coma due to low blood sugar level.
Check her blood glucose level using a Glucometer right away and ask the doctor to start her on 10% dextrose infusion without delay.
She will recover in no time.
Hope that helps.
Above answer was peer-reviewed by :
Dr. Yogesh D
I have two more questions.
1) What clinical signs and symptoms help distinguish a coma caused by an excess of blood glucose and ketone bodies due to a deficiency of insulin from a coma caused by hyperglycemic induced by inadvertent injection of excessive insulin?
2) what is the pathophysiology leading to the elevation of blood glucose after a meal? how does it differs between a patient with insulin-dependent diabetes (IDDM) and those of us with non-insulin dependence diabetes (NIDDM)?
1) What clinical signs and symptoms help distinguish a coma caused by an excess of blood glucose and ketone bodies due to a deficiency of insulin from a coma caused by hyperglycemic induced by inadvertent injection of excessive insulin?
2) what is the pathophysiology leading to the elevation of blood glucose after a meal? how does it differs between a patient with insulin-dependent diabetes (IDDM) and those of us with non-insulin dependence diabetes (NIDDM)?
Brief Answer:
Hypoglycemia associated with classical symptoms.
Detailed Answer:
Hello,
Welcome back and thank you for the follow-up.
To answer your questions, I have to make one correction in your query first, I said hypo (reduced) glycemia, not hyperglycemia.
1. Hyperglycemia and associated ketoacidosis can independently cause coma, that is to say, very high blood sugar levels can cause coma in the absence of ketoacidosis.
This happens usually when the blood sugar levels rise suddenly and the brain hadn't had enough time to adjust to the increased sugar levels in the blood.
This is called hyperosmolar coma.
The basic pathophysiology in hyperosmolar coma is, when the blood sugar level rises to extremely high levels, like above 600 mg/dl etc, the osmotic pressure of blood rises and this causes the water content in the brain to move into the blood vessels which can be quite dangerous.
In addition, the person loses significant amounts of in urine due to such extremely high glucose levels leading to severe dehydration.
Only 20% of diabetic persons with hyperosmolar hyperglycemic state develop coma.
They will usually present with localised neurological deficits, symptoms of extreme dehydration.
Persons with diabetic ketoacidosis however develop electrolyte and metabolic disturbances first and hyperosmolar diuresis later. So they will present with hypokalemia, shallow breathing, dehydration.
Hypoglycemia however is readily identifiable because of the constellation of symptoms and suddenness of the developing coma.
Individuals develop profuse sweating, giddiness, drowsiness, cold and clammy hands and feet, and as the blood sugar level drops further, they go into coma.
But repeated incidents like these make the brain lose the sensitivity and the person may not experience these symptoms with same intensity with successive episodes.
Hypoglycemia develops in diabetics who are insulin and take too much insulin or others who maybe on sulfonylureas.
2. The basic physiology is, once you eat, the glucose in food is absorbed by the intestinal epithelium and is transported in the blood to the entire body, so the blood glucose level increases, as this happens, the pancreas senses the rise in blood glucose level and releases insulin which tells all cells to take more insulin inside them and use it to produce energy.
In insulin dependent diabetes (Type-1), the beta cells that produce insulin are damaged, so enough insulin can not be produced, so more glucose remains in the blood, causing all the problems associated with it.
In, non insulin dependent diabetes (Type-2), there is a resistance developed in the insulin receptors on all the cells to insulin, so even when there is enough insulin, cells do not take up glucose when it rises immediately after the meals.
Glucose levels will rise more drastically in insulin dependent (Type-1) diabetes more than type-2 diabetes.
I can not go on any further as this is taking too much time which tells me that it is beyond the scope of this platform to give you all the information there is about diabetes.
You can read already available online resources on medscape, pubmed, even wikipedia has very good information of diabetes. You can continue your reading there.
I hope I was able to solve your issue.
Best wishes.
Hypoglycemia associated with classical symptoms.
Detailed Answer:
Hello,
Welcome back and thank you for the follow-up.
To answer your questions, I have to make one correction in your query first, I said hypo (reduced) glycemia, not hyperglycemia.
1. Hyperglycemia and associated ketoacidosis can independently cause coma, that is to say, very high blood sugar levels can cause coma in the absence of ketoacidosis.
This happens usually when the blood sugar levels rise suddenly and the brain hadn't had enough time to adjust to the increased sugar levels in the blood.
This is called hyperosmolar coma.
The basic pathophysiology in hyperosmolar coma is, when the blood sugar level rises to extremely high levels, like above 600 mg/dl etc, the osmotic pressure of blood rises and this causes the water content in the brain to move into the blood vessels which can be quite dangerous.
In addition, the person loses significant amounts of in urine due to such extremely high glucose levels leading to severe dehydration.
Only 20% of diabetic persons with hyperosmolar hyperglycemic state develop coma.
They will usually present with localised neurological deficits, symptoms of extreme dehydration.
Persons with diabetic ketoacidosis however develop electrolyte and metabolic disturbances first and hyperosmolar diuresis later. So they will present with hypokalemia, shallow breathing, dehydration.
Hypoglycemia however is readily identifiable because of the constellation of symptoms and suddenness of the developing coma.
Individuals develop profuse sweating, giddiness, drowsiness, cold and clammy hands and feet, and as the blood sugar level drops further, they go into coma.
But repeated incidents like these make the brain lose the sensitivity and the person may not experience these symptoms with same intensity with successive episodes.
Hypoglycemia develops in diabetics who are insulin and take too much insulin or others who maybe on sulfonylureas.
2. The basic physiology is, once you eat, the glucose in food is absorbed by the intestinal epithelium and is transported in the blood to the entire body, so the blood glucose level increases, as this happens, the pancreas senses the rise in blood glucose level and releases insulin which tells all cells to take more insulin inside them and use it to produce energy.
In insulin dependent diabetes (Type-1), the beta cells that produce insulin are damaged, so enough insulin can not be produced, so more glucose remains in the blood, causing all the problems associated with it.
In, non insulin dependent diabetes (Type-2), there is a resistance developed in the insulin receptors on all the cells to insulin, so even when there is enough insulin, cells do not take up glucose when it rises immediately after the meals.
Glucose levels will rise more drastically in insulin dependent (Type-1) diabetes more than type-2 diabetes.
I can not go on any further as this is taking too much time which tells me that it is beyond the scope of this platform to give you all the information there is about diabetes.
You can read already available online resources on medscape, pubmed, even wikipedia has very good information of diabetes. You can continue your reading there.
I hope I was able to solve your issue.
Best wishes.
Above answer was peer-reviewed by :
Dr. Yogesh D
I want to be sure of what the diagnosis is...
Are you saying the diagnosis is hyperglycemia and not hypoglycemia?
Are you saying the diagnosis is hyperglycemia and not hypoglycemia?
Brief Answer:
Please read first answer. Second answer was response to follow-up
Detailed Answer:
Hello,
Welcome back.
Based on your description of the initial symptoms, my probable diagnosis was hypoglycemia.
It is clearly written in my first response. You mentioned that your friend took double dose of insulin, and my diagnosis based on that information was, " hypo " glycemia.
Since I do not know the actual clinical findings and blood glucose levels, I can not confirm that, your hospital should be able to confirm that diagnosis.
Then you asked 2 follow-up questions which were, and I quote,
" I have two more questions.
1) What clinical signs and symptoms help distinguish a coma caused by an excess of blood glucose and ketone bodies due to a deficiency of insulin from a coma caused by hyperglycemic induced by inadvertent injection of excessive insulin?
2) what is the pathophysiology leading to the elevation of blood glucose after a meal? how does it differs between a patient with insulin-dependent diabetes (IDDM) and those of us with non-insulin dependence diabetes (NIDDM)? "
My second response was an answer to those two specific queries you posted.
I hope that clears your doubts.
Best regards
Please read first answer. Second answer was response to follow-up
Detailed Answer:
Hello,
Welcome back.
Based on your description of the initial symptoms, my probable diagnosis was hypoglycemia.
It is clearly written in my first response. You mentioned that your friend took double dose of insulin, and my diagnosis based on that information was, " hypo " glycemia.
Since I do not know the actual clinical findings and blood glucose levels, I can not confirm that, your hospital should be able to confirm that diagnosis.
Then you asked 2 follow-up questions which were, and I quote,
" I have two more questions.
1) What clinical signs and symptoms help distinguish a coma caused by an excess of blood glucose and ketone bodies due to a deficiency of insulin from a coma caused by hyperglycemic induced by inadvertent injection of excessive insulin?
2) what is the pathophysiology leading to the elevation of blood glucose after a meal? how does it differs between a patient with insulin-dependent diabetes (IDDM) and those of us with non-insulin dependence diabetes (NIDDM)? "
My second response was an answer to those two specific queries you posted.
I hope that clears your doubts.
Best regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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