[13] Hyperosmolar Non-Ketotic Coma Flashcards

1
Q

Describe the typical patient with hyperosmolar non-ketotic coma

A

Usually T2DM, often new presentation

Usually older

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2
Q

How long is the symptom history in hyperosmolar non-ketotic coma?

A

Usually long, e.g. a week

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3
Q

What metabolic derangement is seen in hyperosmolar non-ketotic coma?

A

Marked dehydration
Glucose >35mM
Osmolality >340mOsmol/kg

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4
Q

Is there acidosis in hyperosmolar non-ketotic coma?

A

No, as there is no ketogenesis

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5
Q

What complications might arise from hyperosmolar non-ketotic coma?

A

Occlusive events are common, e.g. DVT, stroke

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6
Q

How are occlusive events prevented in hyperosmolar non-ketotic coma?

A

Give LMWH

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7
Q

How is hyperosmolar non-ketotic coma managed?

A

Rehydration

Look for precipitant

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8
Q

How should a patient with hyperosmolar non-ketotic coma be rehydrated?

A

0.9% normal saline over 48 hours, may need about 9L

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9
Q

How long should you wait before starting insulin in hyperosmolar non-ketotic coma?

A

1 hour

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10
Q

Why should you wait an hour before starting insulin in hyperosmolar non-ketotic coma?

A

It may not be needed

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11
Q

How much insulin should you start on in hyperosmolar non-ketotic coma?

A

Low, e.g. 1-3units per hour

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12
Q

Why should you start insulin low in a hyperosmolar non-ketotic coma?

A

To avoid rapid changes in osmolality

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13
Q

What might precipitate hyperosmolar non-ketotic coma?

A

MI
Infection
Bowel infarct

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