Hyperosmolare hyperglyk?mische Entgleisung

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• 作者：Prof. Dr. M. Pfohl (1)
  
• 关键词：Hyperglyk?mie ; Hyperosmolarit?t ; Elektrolytentgleisung ; Insulin ; Diabetisches Koma ; Hypoglycemia ; Hyperosmolarity ; Water–electrolyte imbalance ; Insulin ; Diabetic coma
• 刊名：Der Diabetologe
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：10
• 期：8
• 页码：645-649
• 全文大小：584 KB
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  9. Pfohl M (2014) Coma diabeticum. In: Schatz H, Pfeiffer AFH (Hrsg) Diabetologie kompakt, 5.?Aufl. Springer Verlag
  
• 作者单位：Prof. Dr. M. Pfohl (1)
  
  1. Medizinische Klinik I, Allgemeine Innere Medizin, Diabetologie und Endokrinologie, Evang. Krankenhaus Bethesda Duisburg Gmbh, Heerstr. 210, 47053, Duisburg, Deutschland
  
• ISSN：1860-9724

文摘

The hyperosmolar hyperglycemic state is a relatively rare but life-threatening acute complication of diabetes mellitus. It differs from diabetic ketoacidosis by the lack of ketosis and more pronounced hyperglycemia. The most common causes of hyperosmolar hyperglycemic state are serious infections or the omission of required insulin therapy. Clinically in addition to a massive dehydration with hyperglycemia and electrolyte disturbances, neurological symptoms are common and can range from focal neurological deficits up to deep coma. Plasma glucose values are typically greater than 33.6?mmol/l and in some higher than 56?mmol/l. Plasma osmolality is increased to greater than 320?mosmol/l and there are often marked deficits in sodium and total potassium. Affected patients require consequent intensive care treatment that is focused on balancing the often large fluid deficit in conjunction with close follow-up and balancing of serum electrolytes and intravenous insulin administration. The prognosis of hyperglycemic hyperosmolar state is dependent on the patient’s age, the causative underlying disease, and the quality of intensive care provided.