| ID | 61 |
|---|---|
| Name | HYPOGLYCAEMIC PRECOMA & COMA |
| Cause | |
| Signs Symptoms | |
| Diagnosis | |
| Investigations | Investigation: Blood glucose: less than 2.3mmol/l (40mg/dl). |
| Management | Management: 1. If the patient can drink- 25mg of glucose in orange juice or water by mouth. 2. If the patient comatose, not able to take by mouth- 25gm dextrose i.v (100ml of 25% dextrose) and when the pt. rouses a further 25gm to drink. 3. Glucagon i.m to be given in pt. who cannot be restrained for long enough to give an i.v injection. N.B: in sulphonylurea induced hypoglycaemia- glucagon should not be given. 4. Hypoglycaemia caused by long acting insulins or large doses of any insulin or sulphonylureas then after initial therapy put up a 10% dextrose drip in running for at least 48 hours. The blood sugar monitored by BM stix- should be maintained between 5-7mmol/l. 5. In any case recovery of conciousness should be followed by a good meal. |
| Introduction | hen blood glucose level falls suddenly to a certain level (hypoglycaemia-blood glucose < 2.3mmol/l or 40mg/100ml) precoma or comatose state develops. Spontaneous hypoglycaemia in adults is of two main types: fasting and postprandial. Fasting hypoglycaemia is often subacute or chronic and usually present with neuroglycopenic manifestations; postprandial hypoglycaemia is relatively acute and is often heralded by symptoms of neurogenic autonomic discharge (sweating, plapitations, anxiety, tremulousness). Precipitating factor: Diabetic patients taking more insulin, excessive exercise, less food or taking sulphonyl ureas, alcohol etc. are precipitating hypoglycaemic state. |
| History | |
| Etiology | |
| Clinical Features | Clinical feauture: 1. Onset- sudden. 2. Symptoms- headache, palpitation, sweating, tremor, hunger, lightness of the head, confusion, disorientation, excitability. 3. Signs- moist skin and tongue; high B.P, full bounding pulse, tachycardia; normal or stertorous respiration; dilated pupil; convulsion may be present. Occasionally- hemiplegia or focal fits may be present. 4. Reflexes: may be planter extensor. |
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