Ketogenic coma: What you need to know

Posted by Specialist Doctor II Nguyen Thi Minh Tam - Head of Vinmec Royal City Clinic - Vinmec Royal City International Clinic

Ketosis-induced coma is one of the complications of diabetes and is common in young people. The accurate diagnosis of coma caused by ketoacidosis will help doctors have a direction for timely examination and treatment.

Coma due to ketoacidosis is one of the complications of diabetes mellitus (DM). Accordingly, the complications of diabetes include:
Coma due to ketoacidosis. Coma due to increased blood osmotic pressure. Coma due to lactic acidosis Coma due to hypoglycaemia. The same is a complication of diabetes, but each type of coma has its own disease, its own circumstances, with symptoms that are thought to be the same, but in fact they all have their own distinct points, which are also common points. key to differential diagnosis.

Ketosis-associated coma is a serious and final complication of type 1 diabetes and is common in young, thin people. The cause is insulin deficiency and favorable causes.

Favorable factors
Infection or a serious emergency; Pregnancy is a unique situation in which diabetic ketoacidosis occurs. Stress: acute diarrhea, corticosteroid use, trauma, surgery; Inadequate insulin dose, drug withdrawal, or sudden replacement of insulin with a hypoglycemic sulphamide. Clinical: There are 2 stages
Pre-coma: (compensated acidosis) occurs a few hours/days after high blood sugar. The patient is eating and drinking a lot, suddenly feeling tired, eating less, drinking less, urinating a lot and thirsting a lot. In addition, the patient may have mild shortness of breath, gastrointestinal disturbances such as vomiting, diarrhea and possibly abdominal pain.
Stage of true coma: There are 3 main symptoms:
Coma: Severe consciousness disorder, may be in a deep coma, lying still, not struggling, limbs are soft, muscles, loss of tendon reflexes . Breathing disturbances: Acidosis with deep, rapid breathing (Kusmaul pattern). The smell of acetone is clearly visible. General dehydration: Dry skin, dry mucous membranes, soft eyeballs, less urine due to hypotension. Laboratory tests:
Qualitative testing at the bedside:
Urinary tract: From (3+) to (4+) Very high ketones (3+) - (4+) High capillary blood sugar.

Systematic tests:
High blood sugar > 2 g/L (> 11.12 mmol/L) Very high blood ketones. Urinary tract: several tens of g/L; Xetonuria (3+) to (4+). Severe metabolic acidosis. Electrolyte (Grade) blood: Na normal/low, K increased → normal/low. Anion gap increases. Electrocardiogram: can be high, pointed, symmetrical T waves. In addition, there are conditions of hemoconcentration, increased white blood cells, moderate increase in blood creatinine.

Other complications of diabetic coma
Hyperosmolar coma. Hypoglycemia coma. Lactic acidosis coma. Non-diabetic ketoacidosis
Due to excessive alcohol consumption. The patient has been fasting for too long. Other metabolic acidosis is associated with increased anion gap.

Acute complications can be fatal, often related to treatment errors such as:
Arrhythmia due to hypokalemia. Severe hypoglycemia. Late complications may occur such as:
Infection and septic shock. Cerebral edema due to disturbances in water, electrolytes and acid-base balance. Circulatory complications: Vascular collapse, shock, Acute myocardial infarction Lactic acidosis: in patients with septic shock, shock, necrotizing enterocolitis, or taking metformin: Other complications may occur such as arterial thrombosis; Advanced acute respiratory distress syndrome (ARDS).

Management of coma due to ketoacidosis by the following methods:
Resuscitation of disturbed vital functions; Restore circulating volume; Regulate blood sugar with insulin; Correction of electrolyte disturbances; Correction of acidosis; Treatment of complications; Comprehensive care and nursing. A ketoacidosis coma is one of the complications of diabetes. Accordingly, coma should be examined and treated by a doctor in time to avoid dangers that can lead to death for the patient.