According to abbreviationfinder, HOC stands for Hyperosmolar Coma. Diabetes determines the entire life of those affected. Intensive education about how to deal with the disease can help patients lead their lives as normally as possible and prevent complications such as hyperosmolar coma.
What is a hyperosmolar coma?
Highly elevated blood sugar levels and increased fluid excretion are typical of hyperosmolar coma. The glucose concentration in the urine is so high that it already exceeds the renal threshold.
Hyperosmolar coma is a life-threatening complication of type 2 diabetes and is a subtype of diabetic coma. Unconsciousness is caused by an extreme lack of insulin.
If a hyperosmolar coma occurs, the person affected must be taken to the hospital immediately and hospitalized. These are mostly older type 2 diabetes patients.
Causes
A hyperosmolar coma occurs when the blood sugar level rises extremely sharply due to a lack of insulin. The excess sugar is partially excreted through the kidneys. The sugary urine draws water with it, causing the body to lose a lot of fluids that cannot be compensated for by drinking alone.
A lack of insulin can be caused by an insufficient supply of insulin or an increased need. Inadequate care can occur when a diabetic patient does not inject enough insulin or does not inject in the correct way, when they take too few tablets that lower blood sugar levels, or when the prescribed dose is no longer sufficient.
Older diabetics are often affected, whose pancreas still produces enough insulin to prevent excessive fat breakdown, but not enough to prevent excess glucose formation in the liver. In about 25 percent of cases, it is a case of diabetes that has not yet been recognized and there has therefore been a complete lack of appropriate treatment.
An increased insulin deficiency is caused by an infection in 40 percent of cases, since the blood sugar level is increased during an infection. Type 2 diabetics should definitely bear this in mind when they are ill, for example if they have caught pneumonia or the flu. But an unfavorable diet, an overactive thyroid gland, an operation or other diseases can also lead to an increased need for insulin.
Symptoms, Ailments & Signs
Highly elevated blood sugar levels and increased fluid excretion are typical of hyperosmolar coma. The glucose concentration in the urine is so high that it already exceeds the renal threshold. The body tries to get rid of the unused glucose and excretes it in increased urine output due to the increased osmolarity of glucose.
The result is dehydration, which can lead to unconsciousness. Seizures can also occur. Furthermore, the pronounced glucosuria causes electrolyte disturbances. The small amount of fluid can also cause volume depletion shock. Finally, the kidneys are threatened by acute renal failure.
Electrolyte imbalances primarily have a negative effect on the nerve cells of the brain and are therefore largely responsible for impaired consciousness and seizures. The volume deficiency shock is expressed by a sharp drop in blood pressure, a strong feeling of thirst and also by signs of a clouding of consciousness. In addition to the actual coma, other symptoms can also occur.
These include dizziness, severe thirst, weight loss, dry mouth, severe tiredness, blurred vision, difficulty concentrating, fever, stiff neck and circulatory disorders through to circulatory shock. The loss of fluid causes the blood to thicken, which increases the risk of thrombosis occurring. Pneumonia is also observed. Mortality from hyperosmolar coma is very high. It is between three and 30 percent.
Diagnosis & History
A hyperosmolar coma can be diagnosed with a blood glucose test. As a rule, there is an extremely high value of over 600 milligrams per deciliter.
For comparison: For a non-diabetic, the normal fasting values are 80 to 120 milligrams per deciliter.
The doctor treating you will also carry out a blood test. It tests whether the blood salts potassium and sodium are present in normal amounts. In addition, special parameters are used to determine whether there is an inflammatory focus in the body. In this way it can be determined whether the hyperosmolar coma was triggered by an infection. Further investigations exclude the disease of other organs as a trigger.
The first symptom to be observed is that more water is excreted. As a result, those affected develop extreme and persistent thirst, nausea and vomiting, dry mucous membranes, tachycardia and low blood pressure.
Later, feelings of dizziness and physical weakness are added, and the patient can hardly speak. Eventually, a circulatory collapse occurs. If an infection is the trigger of the hyperosmolar coma, symptoms of the corresponding inflammation also appear.
Complications
This disease causes a number of different symptoms that limit the patient’s everyday life and can significantly reduce their quality of life. As a rule, there is increased thirst and thus increased urination in the patient. The mouth is dry and patients suffer from nausea and vomiting.
Heart palpitations and low blood pressure are not uncommon. The low blood pressure can cause those affected to lose consciousness or even fall into a coma. Various injuries can also occur. In general, a feeling of weakness occurs, combined with tiredness, so that the patient’s resilience is also significantly reduced.
It is not uncommon for temporary thinking disorders or speech disorders to occur and those affected suffer from a lack of concentration. Treatment of this disease takes place with the help of infusions and does not lead to further complications. There is also no reduction in life expectancy. After treatment, the patient’s medication for the diabetes must be readjusted to prevent the condition from reoccurring.
When should you go to the doctor?
Consultation with a doctor is necessary if the person concerned suffers from various ailments over a long period of time. A persistent urge to urinate, which sets in again shortly after the last visit to the toilet, is a warning signal from the body that something is wrong. If there is an increased feeling of thirst, dry mucous membranes in the mouth and throat or a general feeling of internal dryness, a doctor’s visit is necessary. This applies in particular if there is no physical overexertion or if it is very hot.
A seemingly unreasonable intense feeling of thirst should be checked out by a doctor. If you experience symptoms such as vomiting, nausea, dizziness or general weakness, you should see a doctor. If there are further abnormalities or if the existing symptoms increase, a doctor’s visit is necessary. An unusually low blood pressure, a strong need for sleep, permanent tiredness or a pale complexion are indications of diseases that should be checked and treated. If the person concerned suffers from tachycardia, sweating or a feeling of illness, he should see a doctor to have the symptoms clarified. If there is reduced performance, if everyday duties can no longer be fully fulfilled or if digestive problems occur, a doctor should be consulted.
Treatment & Therapy
A hyperosmolar coma is treated in the hospital, often in the intensive care unit. First, the salt and fluid loss must be replaced as quickly as possible. The patients are given about five to six liters of a saline solution by infusion within the first eight hours.
The paramedics usually start with the liquid infusion on the way to the hospital. In addition, insulin is administered intravenously. If necessary, a triggering infection is treated. The metabolism is slowly normalized again under strict observation of the kidney, blood sugar and pH values as well as the electrolyte balance.
The medication for type 2 diabetes is then reset. If the circulatory collapse is not treated appropriately, the affected person slowly becomes unconscious and falls into a deep coma, which in the worst case can end in death.
Outlook & Forecast
The prognosis of hyperosmolar coma is described as unfavorable. In severe cases, the patient does not wake up from the coma and premature death occurs. If the person concerned regains consciousness, he must expect considerable health problems. The acute condition develops in diabetic patients. This is a chronic disease with a potentially progressive course. The patient’s lifestyle is already severely impaired before the comatose state. According to the current scientific and medical possibilities, there is no cure for diabetes.
As a result of the coma, the patient’s existing state of health deteriorated even further. A further decrease in the quality of life and an increase in existing complaints can therefore be expected. In addition, most sufferers develop other disorders.
Once the coma is overcome, the patient’s medication regimen is readjusted. This should prevent a re-triggering of the hyperosmolar coma and have a preventive effect. In addition, the current complaints are reassessed and the treatment plan is optimized. If the patient cooperates and follows the doctor’s instructions, significant improvements can be observed. Although there is no prospect of recovery, an adequate lifestyle can still be established.
Prevention
The most important preventive measure for diabetic patients is that they get enough information about their disease. In order to prevent a hyperosmolar coma, they must measure their blood sugar levels regularly and be able to quickly identify rising levels, for example during an infection. In the case of elevated blood sugar levels, the insulin dose must be adjusted accordingly. Special training courses for diabetes patients explain complications and give tips for dealing with the disease on a day-to-day basis. It is also important to always drink enough, at least two liters per day are recommended.
Aftercare
The risk of a hyperosmolar coma can be identified during follow-up care through careful monitoring. To this end, it is important that diabetics are aware of the risks and monitor their blood sugar closely. This includes adjusting the daily dose of insulin to daily activities and meals. Increased attention helps to recognize any changes as warning signs.
If a diabetic coma is suspected, rapid countermeasures are required. A visit to the doctor or a call to the emergency service initiates the further steps. Following the initial treatment with insulin and plenty of fluids, a longer-term observation takes place. This focuses on changing the blood sugar level and on the stability of the patient.
The comprehensive education of the persons at risk is an important contribution in the context of safe aftercare. In order to prepare for an acute emergency, those affected need the appropriate medication. Involving family members is also useful.
In an emergency, if the patient is no longer responsive, they can take the necessary measures. The regular follow-up appointments also include nephrological, ophthalmological and family doctor check-ups. These are intended to ensure that diabetes does not lead to serious complications such as kidney problems, blindness or a diabetic foot.
You can do that yourself
Relatives of a diagnosed diabetic and the patient themselves usually recognize the signs of a disturbed blood sugar level very early on. However, if the metabolism derails too quickly or unnoticed, there is often no time for prophylactic measures.
If the person concerned falls into the hyperosmolar coma, he is in a life-threatening emergency situation. This is a state of deep unconsciousness. This means that the heartbeat and breathing are still there, but the conscious existence is switched off. Likewise, the person affected no longer has vital protective reflexes. For this reason, no attempts should be made to eat. The affected person has neither swallowing nor coughing reflexes. There is a risk of aspiration and therefore the likelihood of suffocation.
The only way to help yourself is to act quickly and measure your blood sugar level. The person concerned must be brought into the stable lateral position as quickly as possible and the emergency services called. During the waiting period, it is important to check breathing regularly and, if necessary, to carry out mouth-to-nose resuscitation. Cardiopulmonary resuscitation must be carried out if the patient’s spontaneous breathing seems insufficient or if their skin turns bluish. If several helpers are on site, the CPR should be carried out in rotation and without a break. This is necessary until the emergency services have arrived at the scene of the emergency.
