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Acute cerebrovascular disease and hyperosmolar nonketotic diabetic coma of 26 cases


Patients presented with prominent neuropsychiatric symptoms. The possible reasons are: older age, brain function is poor, extremely high blood sugar, severe dehydration, blood concentration, increased aldosterone secretion secondary to high serum sodium increased, so that increased plasma osmolality, brain cells in dehydration, which led to prominent nerve psychiatric symptoms [2]. Clinicians usually only pay attention to the neglect of the performance of the nervous system-related illness resulting in missed diagnosis. Missed a large number of applications is often aggravated by dehydration hypernatremia,[link widoczny dla zalogowanych], plasma osmolality increased dehydration of brain cells, there were loss of consciousness, induced hyperosmolar coma. So. When patients with acute cerebrovascular disease were unexplained loss of consciousness, it is difficult to explain with acute cerebrovascular disease, should take into account the hyperosmolar coma early time check blood sugar, serum sodium, blood urea nitrogen and other biochemical markers. To early diagnosis and early treatment. In the treatment of acute disease in the mad should be considered if the following conditions may be complicated by hyperosmolar coma: ① dehydrating agent in the application of effective treatment and even more severe disturbance of consciousness deep coma, with the primary lesion can not explain. ② disturbance of consciousness with dehydration, but urine output continues to rise by more or hyponatremia. ⑧ epileptic seizures occurred. Early acute cerebrovascular disease often leads to stress hyperglycemia, as the sympathetic-adrenal stress response and the pituitary-adrenal system activation, insulin insufficiency, small roar of receptor activation changes and reduced insulin sensitivity, leading to high blood sugar l_3], increase and cover with acute cerebrovascular disease and hyperosmolar coma. In conclusion, our data, acute cerebrovascular disease and clinical features of hyperosmolar coma are: ① common in 6O years of age or older. ② severe acute cerebrovascular disease,[link widoczny dla zalogowanych], mostly for large infarction or hemorrhage, or significant parts of infarction or hemorrhage. ③ may have highlighted the spirit of the neurological symptoms without obvious symptoms of diabetes. ④ severity and blood glucose, serum sodium, osmotic pressure was positively correlated]. ⑤ Most dehydrating agent, dexamethasone, a larger amount, longer. And a lot of fluid, dehydration, application of hypertonic glucose induced and aggravated the condition. The treatment of acute cerebrovascular disease and conflicts between hyperosmolar coma, acute cerebrovascular disease can be induced increase dehydration therapy hyperosmolar coma, hyperosmolar coma and require a lot of rehydration therapy may aggravate cerebral edema, acute cerebrovascular disease so hypertonic coma in patients with intravenous fluid replacement should be, the combination of oral or intragastric injection, intravenous infusion rate should not be too fast to make finished within 24 ~ 48h of total water loss is appropriate to supplement the normal saline or Ringer's solution-based, as far as possible do not make hypotonic saline. Animal experiments have shown that high glucose increased blood pressure, neurological symptoms of rats with cerebral infarction, infarct expansion, increased brain edema, complicated by cerebral hemorrhage, increased mortality. Prevention and treatment of insulin with the role of cerebral ischemic damage [s]. Therefore, early detection, early treatment can improve the prognosis of patients with a large degree. Table 1, Table 2 shows that the prognosis of patients with hyponatremia, the level of plasma osmolality. Sodium, plasma osmolality higher mortality is high, more than deaths due to sodium, plasma osmolality can not be corrected after treatment and died. The data show that acute cerebrovascular disease in patients with hyperosmolar coma,[link widoczny dla zalogowanych], and improved survival reasons, may be timely diagnosis system, the application of patients with dehydration, water shortage and water loss caused by physical and so easy to correct the leaving condition improved; and deaths with high sodium, high osmotic pressure are from the central factors that may damage the hypothalamus and the Department of lesions osmoreceptors. Cause aldosterone (ADH) secretion abnormalities, ACTH, ADH secretion caused by brain-derived excessive hypernatremia [2]. Therefore, deaths after treatment is often significantly lower blood glucose, but serum sodium and plasma osmolality after treatment was no decrease or increase. Therefore,[link widoczny dla zalogowanych], acute cerebrovascular disease and hyperosmolar coma to early diagnosis and treatment, to facilitate timely correction of early high blood sugar, high sodium, high osmotic pressure and reduce mortality. [
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