Symptoms and first signs of the hypoglycemic coma. Hyogolcemic Coma

31.10.2020

Director of the Clinic Institute of the Brain Institute, D.M., Professor of the Department of Nervous Diseases and Anesthesiology-resuscitation, Ural State Medical Academy, Chairman of the Supervisory Board of Ano "Clinical Brain Institute".

Deputy Chief Doctor for Medical Work, KMN, Neurologist

Head of the Neurological Department, neurologist

Under the term hyogolcemic Coma It is understood by the acute state associated with the oppression, in a certain sequence, the operation of the central nervous system, due to the sharp drop in the concentration of carbohydrates (sugars) in the blood associated with their decline.

The sequence of oppression of the CNS comes from the highest nerve structures - the bark of large hemispheres to the gradual oppression of subcortical structures and centers of the oblong brain. The hypoglycemic coma is developing sharp and requires emergency medical care, with non-appearances of which the risk of fatal outcome is significantly increasing, due to the oppression of the respiratory and cardiovascular activities of the body.

Clinical picture and symptoms

Symptoms of the hypoglycemic coma are well studied and represent a number of characteristic features. Knowledge of the symptoms of the hypoglycemic coma can save the life of the victim from her. Its useful to note. That the symptoms develop in proportion to the oppression of brain functions as a result of trophic failure. The symptoms are characteristic of it:

Shake hands and brushes. In the future, the shake of the lower limbs and the entire body is joined.
Fast rapid feeling of hunger.
A person is worried about the heat, the sweating of the limbs increases. And then and the whole body.
Greater weakness increases.
The number of heart abbreviations, the patient worries the heartbeat.

In the absence of help, the condition of the victim begins to deteriorate, and the above symptoms begin to modify. More serious disorders arise:

Pallor skin.
Cramps.
Bradycardia is a decrease in the number of heartfills and hypotension - decrease in blood pressure.
Hypothermia.
Depression of consciousness.

Symptoms are developing consistently as described above, it is often possible to determine the severity of the pathological condition.

Causes of the development of the hypoccemic coma

The causes of the hypoglycemic coma are in the acute insufficiency of sugars in the blood. The main nutritional substrate for nervous tissue is glucose, the concentration of which in the blood is normal from 3.3 to 5.9 mmol / l. With a decrease in the amount of glucose below 3 mmol / l. Nervous CNS cells begin to feel lack of food and their functional activity is sharply reduced, which causes symptoms characteristic of the hypoglycemic coma. The clinical institution of the brain specializes in the study of the pathogenetic mechanism for the development of the hypoglycemic coma and has highly qualified specialists with impressive experience of treating patients with data from the disease.

Methods of therapy

A person in a state of hypoglycemic coma needs urgent hospitalization and must be in stationary treatment while the health condition will not be stabilized. Assistance in the hypoglycemic coma should conduct an experienced specialist! Treatment is to carry out a number of measures related to intensive therapy. The first thing is the blood hypoglycemia, then special auxiliary activities are held to the patient aimed at maintaining cardiovascular and respiratory systems. Correction of metabolic disorders is performed. Only after all of the above events, the development of the hypoglycemic coma is possible to eliminate.

Possible complications

The development of the hypoglycemic coma can lead to severe dysmetabolic violations that most organs and systems damage. In the development of the hypoglycemic coma, the removal of acetone from the body is disturbed. The accumulation of acetone in the blood leads to intoxication of the body. The most serious complications are associated with the oppression of the alternating brain of the alternate brain. In the development of deep coma, death is possible due to cardiovascular and respiratory failure.

First aid

With the initial stages of the hypoglycemic coma, while the patient is still in consciousness it is necessary to give him a sweet strong tea or any other sweet food. Be sure to call ambulance and fix the time of the beginning of the disease, check with the victim of which kind and how much he introduced insulin.

Under hypoglycemia These or other clinical symptoms appear in patients with a decrease in the level of glycemia below 3 mmol / l; However, in patients with diabetes diabetes (SD), which are in insulin therapy, symptoms of hypoglycemia may also appear with sharp fluctuations (drops) of the level of glycemia - when blood sugar is rapidly decreasing with high numbers, but not achieving low levels; Hypoglycemia can develop and against the background of treatment with tableted sugar-based drugs (group of glibenklamide - maninyl and its analogs) of nuclear-orphan diabetes. Deep hypoglycemic coma comes usually with a decrease in glycemia to 1-2 mmol / l.

The basis of the pathogenesis of hypoglycemia It lies a sharp decrease in glucose intake in cells (neurons) of the brain (carbohydrate and oxygen starvation of the brain), which leads to a violation of the psyche, consciousness - up to the development of deep coma.

Hypoglycemic Coma Clinic

Hyogolcemic Coma (On the background of insulin therapy) develops quickly, suddenly, for 15-30 minutes, nevertheless, in the clinic it is possible to distinguish the initial stage, the stage of mental disorders with the excitation or without it and the stage itself (complete) hypoglycemic coma.

Initial the stage of the hypoglycemic coma characterized by a sudden general weakness, profuse sweating, trembling the whole body, a feeling of hunger; There may be headache, heartbeat, numbness of lips, language, paresthesia, diplopia. Children often observed nausea, vomiting, depressed mood, sometimes excitation, aggressiveness. In the absence of help, in a few minutes the state of psychosis is developing: the patient's behavior can resemble alcohol intoxication, often observed aggressiveness, negativism, unmotivated actions; Patients may have auditory, visual hallucinations. The patient in this stage of the coma is insane.
Then join clone-tonic convulsions, Overweight comes, comporarous condition and complete loss of consciousness - coma.

In case of inspection, the following are characteristic. symptoms of hypoglycemic coma: Respiratory smooth, humm skin, muscle hypertonus, moderate tachycardia, sometimes bradycardia, blood pressure is normal or slightly increased. The hypoglycemic coma may be complicated by the development of the brain edema, which is observed or during late diagnosis, and, accordingly, lately begins, or as a result of inadequate therapy.

Diagnosis of hypoglycemic coma

In the event of hypoglycemia Outside the house, the lack of medical documents can make it difficult to make a diagnosis. In suspected of a patient's development of hypoglycemia with a medical-diagnostic target, an intravenous 40-60 ml of 40% glucose can be administered at the prehospital stage. If no more than 1 hour has passed since the development of the hypoglycemic coma, then, after administration, 40-60 ml glucose is an improvement in the state of the patient before the restoration of consciousness occurs. The diagnosis of the hypoglycemic coma is finally confirmed by the study of blood glucose when the low level of glycemia is found.
We remind you that hypoglycemia clinic It may develop and with a quick drop in the level of glycemia with high numbers to normal values \u200b\u200bdue to the introduction of high doses of insulin.

Emergency care for hypoglycemic coma.

In the initial stage of hypoglycemia It can be engaged in the inside of easily digestible carbohydrates - sweet tea, jam, sugar, candy - in patients preserved a silent reflex. At the stage of mental disorders or in the development of deep coma, emergency assistance turns out to be a 40% glucose solution in Vienna. The amount of glucose influx depends on the degree of recovery rate of consciousness, in severe cases of the hypoglycemic coma, it may be necessary to introduce up to 100-150 ml of 40% glucose solution. In the case of a tightened heavy hypoglycemia, despite the infusion of large doses of glucose, if the consciousness is not restored, this may indicate the development of the complication - the brain edema. At the same time, it is desirable to keep a patient together with a neurologist.

The hypoglycemic coma is the critical condition of the human body, which occurs due to a sharp drop in blood glucose concentration. It requires emergency medical care, since in case of delay it can easily lead to death.

When providing first regenerating activities, it is necessary to compulsory concretization of the state and differentiation of hypoglycemia from hyperglycemia. Often, incorrect medical care is caused by the development of serious pathologies of nervous or cardiovascular systems.

The reasons

Hypoglycemia - a phenomenon in which the blood glucose level falls below 3.5 mmol / liter. Such a state may be caused by the following reasons:

Long-term ignoring hypoglycemia;
Consumption of a large amount of alcoholic beverages;
Introduction of large doses of insulin;
Reception of some drugs;
Excessive physical activity;
Unbalanced poor nutrition.

In the overwhelming majority of cases, the hypoglycemic coma is preceded by an insulin injection. This consequence speaks of incorrect procedure.

Doctors have allocated the following common mistakes when due to their own inattention, the patient faces this phenomenon:

Symptoms

Hypoglycemic coma is characterized by rapid development. However, its flow can still be divided into separate stages.

Doctors adhere to the following classification:

If you bring the condition of a person to the fifth stage, there is a serious risk of fatal outcome. A sharp decline in blood glucose levels can cause a brain edema at which the cortex shells are destroyed. In the future, this will affect all the processes in the body.

The reasons for such a consequence may have a long lack of help in the development of hypoglycemic state or erroneous injection of insulin.

Recognize the first signs of brain edema can be in disruption of breathing, increasing body temperature, change in cardiac rhythm, nausea and vomiting.

Also, a person may have remote consequences. Usually, they can only be removed in a few months. Often, people who survived the hypoglycemic to whom arises epilepsy, encephalopathy or Parkinsonism.

The principle of the development of the hypoglycemic coma in children is exactly the same as in adults. It is possible to provoke such a phenomenon for a long-term fasting or compliance with low-calorie diets, as well as incorrect insulin administration or the consequences of chronic diseases.

Also, the cause may be improper nutrition or insufficiency of enzymes. The hypoglycemic computer in children is high danger, since it is not always possible to diagnose it in the initial stages. The child is not able to accurately and clearly describe what it bothers him.

Usually parents begin to beat the alarm when their children begin to show anxiety or become overly plasticia. Due to increasing pain in their abdomen, they decrease or completely absent appetite. It is hunger that is an accurate sign of developing hypoglycemia. Over time, children become sluggish, non-contact, indifferent to everything that is happening. All such changes must necessarily alert any parent.

The hypoglycemic computer in children, as in adults, is preceded by an excessive paleness of the skin, the tremor of the limbs, high sweating. In case of any sharp movement, a pre-corrupt state is developing, the child loses consciousness for a few seconds.

It should be borne in mind that the manifestation of this state in children develop much rapidly than in adults. The symptoms of such a state do not differ in them. The earlier you cause an ambulance aid, the higher the risk of maintaining the normal activity of the body.

Diagnostics

In the initial stages to determine the hypoglycemic to whom it is difficult. Symptoms of such a state can easily be confused with other diseases, because of which a person does not receive the necessary treatment. First of all, it is necessary to visually inspect the person, measure its pressure, pulse, evaluate the general condition. However, just to say, the hypoglycemic coma is or not, only a common blood test will be able.

Usually it shows the following results:

The first symptoms appear when the blood glucose level falls below 3.5 mmol / l.
When sugar drops to 1.66-2.77 mmol / l, a person has all signs of hypoglycemia.
At sugar concentration 1.38-1.65 mmol / l, a person loses consciousness.

When diagnosing a hypoglycemic state, a particular importance is to determine the reduction rate of glycemia. If the patient has non-compatinated insulin-dependent diabetes, It develops in glycemia elevated or normal - 11.1 mmol / liter. This happens if the decline occurs with extremely high levels.

Other diagnostic studies in the hypoglycemic coma do not have practical importance. There is no glucose in the urine, biochemical analysis shows a decrease in the concentration of hepatic enzymes. The diagnosis is made only after low glycemia is confirmed.

First aid - an important component of therapy. From its correctness will depend on whether a person will face with serious complications or will be able to avoid them.

Typically, the following manipulations are carried out in such a state to improve the health of the patient:

The greatest efficiency in the binding of the attack of the hypoglycemic coma has a sugar solution. He can only be used if a person is conscious. To prepare such a medicine, it is necessary to dissolve several sugar tablespoons in a glass of boiled water.

If you are aware of human disease and have medical knowledge, you can introduce adrenaline cube and a glucose solution intravenously. However, consider that all the consequences will be at you.

Treatment

If the beginning of the attack is timely suspected in a timely manner, you can easily stop it yourself. To do this, it is enough to eat a little bread and drink some sweet drink: tea or a conventional sugar solution.

You can also use other quick carbohydrate products: honey, candy, flour, harvest. Take products with an interval of 10-15 minutes until the attacks are completely destroyed. If no effect followed, immediately call the doctor.

If a timely diagnose hypoglycemic who failed, the help will have already qualified doctors. With a severe flow with a loss of consciousness, a solution of glucose intravenously is injected with a patient. This is usually enough to restore the normal activity of the body. If after 15 minutes no improvement followed, the specialist repeats the procedure, but already with drip administration.

The introduction of 1 ml glucagon intravenously, intramuscularly and subcutaneously is prescribed. Such measures help to return a person in consciousness after 10-20 minutes. If necessary, the introduction of glucagon can be repeated.

With the extremely severe course of the hypoglycemic coma, the patient prescribe intramuscular or intravenous maintenance of 150-200 ml of hydrocortisone. It helps restore the pancreas. If the patient does not return to consciousness, it continues to introduce glucose solution intravenously.

Also every 2 hours there are several ml of glucagon, prednisone and hydrocortisone to restore the work of the kidneys.

In order to prevent the development of the edema of the brain shells, the specialist introduces the mutnitol solution to the patient. It helps to normalize metabolic processes, and also prevents congestive phenomena. If necessary, cardiovascular preparations are introduced. After the relief, the person remains under the control of the doctor for several days.

Prevention

The prevention of the hypoglycemic coma is to fulfill all the prescriptions of the attending physician. People who suffer from diabetes must consume a drug in a strictly selected dosage and scheme.

Also necessary Comply with a special diet And follow the intensity of any physical exertion.

Try to face as possible with stress and emotional overvoltages. They can negatively affect the work of all regulatory glands.

Any violations of carbohydrate exchange are of serious danger not only for health, but also for human life. Most often with such a problem, patients suffering from diabetes are faced.

Hypoglycemic coma is a critical state, the manifestation of which is caused by a sharp decrease in blood sugar levels. Glucose is the main source of food of the cerebral cells, so first of all, he suffers from the lack of needed sugar.

The rapidness of the development of symptoms requires emergency care in the development of hypoglycemic. At the same time, the competent actions of eyewitnesses or the most patient before the arrival of physicians make it possible to prevent the onset of the comatose state.

Important moments

Disturb exchange of carbohydrates are 2 types:

Improving blood sugar ();
Lowering blood sugar (hypoglycemia).

At the same time, the symptoms of the hyper and gipo of states are very similar, and the methods of providing medical care are different. Therefore, it is important to know the features of the manifestations of these states.

Hyperglycemia is characterized by such symptoms:

The constant sensation of thirst, which becomes more intense with each minute;
Nausea and pronounced weakness;
The patient has dry skin drying;
The tone of the eyeballs is reduced;
Most often, the patient is the resistant smell of acetone.

The state of hypoglycemia has similar symptoms with hyperglycemia, but in addition to the total decline of forces, the patient has a trembling and strong sweating.

Most often, people with diabetes have special devices that allow measurement of blood sugar. In this case, you need to measure readings with them to make sure the diagnosis accuracy.

Symptomatics

Hypoglycemia in the first hour of development is quite difficult to recognize, as it has fuzzy manifestations.

The beginning of the process is characterized by the starvation of the cerebral cells due to a reduced amount of glucose admission to it. The synthesis of energy from reserve reserves begins, from substances not intended for these purposes.

The first symptoms appear, which indicate the state of the ancestors:

Rapidly increasing general weakness, which replaces aggressive excitability;
Headache, which is not amenable to stopping;
Reduction of concentration and attention;
A strong sense of hunger;
Hands and legs become cold;
Foot and - wet;
The thermoregulation is disturbed, due to which the patient is experiencing heat seizures.

Proponial assistance in such states is extremely important, because thanks to it, the state of the coma can be avoided.

Help the patient simply. To do this, you need to give it a sweet tea. If the condition is rapidly deteriorating, the sweet liquid is given to drinking small spoons, constantly being near a person.

Note!

Raise blood sugar with chocolate or sweet candy is undesirable. First, they are slower than sugar.

Secondly, the development of hypoglycemia is often rapid, so the loss of consciousness may occur just at the moment when the patient eats candy. In this case, the patient is necessarily suppressed by it, which will greatly aggravate and so a difficult situation.

If the symptomatics remains without attention and the body will not receive the amount of glucose in time, the patient's condition will begin to deteriorate rapidly:

Violated visual acuity;
In the area of \u200b\u200bthe nose and lips, a person will begin to feel tingling;
Will appear with minor physical exertion;
Strong hand shake;
Increasing tachycardia;
Coordination violation.

As a rule, the symptoms grow rapidly, and through a short time a person is already unconscious, a hypoglycemic coma comes.

Emergency assistance in the hypoglycemic coma requires urgent intervention of physicians. Therefore, if you witnessed the loss of the consciousness of a person who has been observed above the symptoms, you need to call an ambulance brigade.

Actions obvious

In the hypoglycemic coma, first aid is to ensure human safety and includes the following actions:

Put the patient horizontally;
Turn on side;
Fixed prior to the arrival of physicians vital indicators: heartbeat, breathing, pulse.

Note!

Contrary to the common belief that liquid with sugar must be poured into the mouth of the victim even in a state of fainting, it is impossible to do this!

If you have the practice of introducing intramuscular injections and the Glucagon preparation, you need to immediately make an injection.

Almost all patients suffering from diabetes mellitus are needed with themselves the necessary medicines. Therefore, examine the things of a person if it is unconscious. If a person is still in a state of the ancestors, check if he has the necessary drugs, as well as in which dosage they should be taken.

"Glucagon" can be administered to any part of the body under the skin or in the muscle. In emergency situations, injection is put through clothes, as there is no time for disinfection in this case.

If before the arrival of the medical personnel, the person came to himself, should continue to assist him. To do this, you need to perform the following actions:

Give a sweet drink sweet drink or to eat sweetness;
After taking sweet food and drink, they offer food rich in carbohydrates.

Doctors will continue drug assistance to the introduction of a 40% glucose solution in Vienna.

Further treatment will be due to the reasons for the appearance of hypoglycemia and the time segment of finding a patient in a comatose state.

Causes of urgent state

What is the reason for the reduction of sugar concentration? There are a lot of reasons. However, doctors allocate 2 categories of circumstances that can lead to a hypoglycemic coma.

1 Group of reasons - an overabundance of insulin in the blood. The main task of insulin is the transportation of glucose into organs and fabrics. In the case when its number is exceeded, almost all glucose gets out of plasma in the tissue, and it is the minimum part of it.

Insulin's overabundancy is most often found in patients with an insulin-dependent form of diabetes. This is due to such factors:

Incorrectly calculated dosage of the drug without taking into account the concentration of the means.
It is also necessary to carefully treat the selection of syringes. For insulin injections, special insulin syringes are used, on which the number of units corresponding to a specific dosage is labeled.
Incorrectly chosen technique for administration of the drug: insulin injections are carried out only under the skin. In case of drugs in the muscular fabric, its concentration will increase dramatically.

Patients with diseases of the pancreas are also inclined to hypoglycemia, when the organ produces a lot of insulin.

The second group of factors provoking hypoglycemic include improper nutrition and distribution of physical exertion. In this case, the concentration of insulin in the blood does not exceed the norm, but the amount of sugar is reduced.

The use of alcohol primarily affects the functioning of the liver. In this body, as is well known, the synthesis of all necessary blood components occurs. Ethyl alcohol enhances the load on the liver, due to this glycogen does not have the ability to break up to the level of glucose, which supports the required level of sugar before and after meals. As a result, 2-3 hours after eating the amount of glucose in the blood drops.

Women who often use a sahamaging diet or limit the consumption of carbohydrates, are also susceptible to hypoglycemia.

Stresses, excessive physical exertion, long-term depression - states provoking a decrease in blood sugar.

The hypoglycemic coma is the critical state of the endocrine system, arising against the background of a sharp drop in blood levels of sugar (that is, glucose). The first assistance in the hypoglycemic coma is required by the patient without delay, but assistance provides for the need to concretize the state, that is, the determination of whether the symptoms of hyperglycemia is present (with an excess of glucose blood), or the actual state of hypoglycemia is relevant.

Symptoms of hyperglycemia and hypoglycemia

Symptoms of hyperglycemia In the acute or in the chronic form of the flow, are concluded in the following manifestations:

thirst, features excessive;
student urination;
fatigue;
weight loss;
blurred vision;
itching skin, dry skin;
dryness in the oral cavity;
kussmouul's breath;
poorly cured with the use of traditional therapy sluggish infections (, vaginal);
coma.

Hyperglycemia in acute form can additionally manifest themselves in the following states:

violation of consciousness;
ketoacidosis;
dehydration on the background of osmotic diuresis and glucose.

Symptoms of hypoglycemia are divided into vegetative (adrenergic, parasympathetic) and neuroglycopenic. The symptoms of the vegetative form is characterized by the following manifestations:

increased arousal and aggressiveness, fear, anxiety, anxiety;
excessive sweating;
muscle tremor (trembling), muscular hypertonus;
an increase in blood pressure;
expansion of pupils;
pallitude of the skin;
arrhythmias;
nausea, it is possible - vomiting;
weakness;
hunger.

Neuroglycoenic symptoms manifests as follows:

reduced quality concentration;
dizziness, headache;
disorientation;
disorders in coordination of movements;
paresthesia;
"Twist" in the eyes;
inadequacy behavior;
amnesia;
circulatory disorders and breathing;
drowsiness;
violations of consciousness;
pre-corrosive condition, fainting;
coma.

Causes of hypoglycemic coma

prolonged use of certain medical preparations;
overdose of insulin preparations;
violation of the diet, alcohol intake;
psycho-emotional tension, neurosis, reduced mood, depression and stress;
tumor in the area of \u200b\u200bthe pancreas, redundancy of insulin production;
overvoltage of physical scale (with severe physical work, during sports).

Complications of the hypoglycemic coma

The first aid for the hypoglycemic coma is extremely important for the patient, while in particular it is important how quickly the people who are in the close proximity of this state are reacted. The importance of providing such assistance is that its absence can lead to a brain edema, and this, in turn, provokes the occurrence of irreversible in the consequences of lesions of the central nervous system.

It should be noted that with frequent attacks of hypoglycemia, as well as with frequent state of the hypoglycemic coma, adult patients face changes in personality, while children have a decrease in intelligence. It is not excluded in both cases the possibility of fatal outcome.

As for the state of the hypoglycemic coma in individuals of the elderly, and especially those of those who are relevant / and cardiovascular diseases, it is especially dangerous, because as a complication of his flow can perform either.

Given this feature, it is mandatory to pass an ECG after the symptoms of hypoglycemia will be stopped. With prolonged episodes of the hypoglycemic coma, accompanied by the severity of the characteristic of the manifestations, may occur, that is, the diffuse brain lesion in the complex with oxygen starvation and blood supply disorder in the cerebral tissue. At the same time, the death of nerve cells occurs, the degradation of the person is noted.

First aid for hypoglycemic coma: precautions

To proper first aid in condition caused by the hypoglycemic room, it is important to clearly determine which of the symptoms of this state indicate hyperglycemia (in which the level of glucose increases in the blood), and which is about hypoglycemia (at which, accordingly, the glucose level is reduced). The fact is that both of these cases require the implementation of measures opposite to each other.

We will remind our readers that the high level of sugar is accompanied by an increase in thirst, weakness and nausea. The unconscious state is accompanied by dry skin and a common decrease in the tone of eyeballs. In addition, the patient notes a noisy pronounced breathing with a characteristic "apple" smell and acetone. If the patient is relevant to lower sugar levels, then there is a pronounced weakness and trembling on the body, abundant sweating. The unconscious state may be accompanied by convulsions and the lack of a corneal reaction in response to touch.

Injecting insulin is needed to withdraw a person in a state of diabetic coma (hyperglycemic coma) in urgency. As a rule, in diabetes patients, there is a first-aid kit with him, in which there is everything that this injection is needed (instructions for dosage, rolling, alcohol, syringes and, actually insulin).

Considering the fact that patients who actually face the condition under consideration have a reduced immunity, it is important to exclude the possibility of infection of the fields of the area of \u200b\u200bUkolov, as well as in strict order to observe the measuresset of insulin as usual. That is why in order to provide first aid with a hyperglycemic coma in the conditions of the street, in accordance with this requirement, it is necessary, first of all, to search for a patient for the presence of a first-aid kit with insulin. In the presence of such, the introduction of the dose of insulin (50-100-day) is made in the thigh or in the shoulder. Considering the fact that the patient may certainly have traces of injections, orient to navigate it.

Mind of "ambulance", because, at the same time as insulin, it will require the administration of a solution of glucose solution (40%) and saline with a solution of glucose (about 4000 ml, 5%). Further, over the next few hours from the moment of insulin introduction, the volume of consumed fats and proteins is reduced, food intakes must enter into order of 300 grams (minimum) of easily digestible carbohydrates (kisins, fruits and juices), are recommended to use alkaline mineral water.