DKA 98 Tabriz 2

Coma in diabetics

Abnormal glycaemia

(a) Hypoglycaemic

(b) Hyperglycaemic: (i) ketoacidotic, (ii) non-ketoacidotic

Other metabolic, consequent upon the diabetic state

(a) Uraemic coma, with or without glycaemic upset

(b) Lactic acidosis, with or without glycaemic upset

(c) Alcoholic coma, with possible abnormalities in ‘ketone bodies’, lactate, or glucose

Non-metabolic coma

For example, subarachnoid haemorrhage 

MAJOR ACUTE COMPLICATIONS

Metabolic problems

■ Nonketotic hyperosmolar hyperglycemic coma 

■ Hypoglycemia

■ Diabetic Ketoacidosis (unlikely in type II diabetes mellitus except during periods of stress such as those caused by trauma and intercurrent infection or disease)

■ Lactic acidosis

Infection

Hyperglycemic crises

DKA, NKHHC

Acute complications of DM

DKA

 ► Acute complication of type 1 DM

► Occasionally occurs in type 2 DM

► An Endocrine Emergency

► With a mortality rate of 5 – 10%

► Life threatening condition but preventable in many cases

► Results form absolute insulin deficiency or relative insulin deficiency combined with counter-regulatory hormones excess (mainly glucagon excess)