[13] Hyperosmolar Non-Ketotic Coma Flashcards
Describe the typical patient with hyperosmolar non-ketotic coma
Usually T2DM, often new presentation
Usually older
How long is the symptom history in hyperosmolar non-ketotic coma?
Usually long, e.g. a week
What metabolic derangement is seen in hyperosmolar non-ketotic coma?
Marked dehydration
Glucose >35mM
Osmolality >340mOsmol/kg
Is there acidosis in hyperosmolar non-ketotic coma?
No, as there is no ketogenesis
What complications might arise from hyperosmolar non-ketotic coma?
Occlusive events are common, e.g. DVT, stroke
How are occlusive events prevented in hyperosmolar non-ketotic coma?
Give LMWH
How is hyperosmolar non-ketotic coma managed?
Rehydration
Look for precipitant
How should a patient with hyperosmolar non-ketotic coma be rehydrated?
0.9% normal saline over 48 hours, may need about 9L
How long should you wait before starting insulin in hyperosmolar non-ketotic coma?
1 hour
Why should you wait an hour before starting insulin in hyperosmolar non-ketotic coma?
It may not be needed
How much insulin should you start on in hyperosmolar non-ketotic coma?
Low, e.g. 1-3units per hour
Why should you start insulin low in a hyperosmolar non-ketotic coma?
To avoid rapid changes in osmolality
What might precipitate hyperosmolar non-ketotic coma?
MI
Infection
Bowel infarct