Diabetic Coma Is Missing

Letter to the Editor Acute Onset of Impaired Consciousness Diagnostic Evaluation in the Emergency Department by Dr. med. Tobias Weiglein, PD Dr. med. Markus Zimmermann, PD Dr. med. Wolf-Dirk Niesen, Prof. Dr. med. Florian Hoffmann, and Prof. Dr. med. Matthias Klein in issue 15/2024

In the article on acute onset of impaired consciousness (1), two life-threatening acute complications of the very common disease Diabetes mellitus that are accompanied by impaired consciousness are missing: ketoacidotic and hyperosmolar diabetic coma (2). The “classic” diabetic coma—metabolic (keto)acidosis with hyperglycemia as a result of absolute insulin deficiency—can take a fatal course if—as a result of delayed and/or excessive insulin dosage and lowering of blood glucose—cerebral edema develops. Hyperosmolar diabetic coma—extreme hyperglycemia without accompanying ketoacidosis—also has a high case fatality rate, as a result of cerebral edema or central pontine myelinolysis. Clinical red flags are—in addition to peracute progressive impairment of consciousness even before treatment—Kussmaul respiration in ketoacidotic coma and exsiccosis in hyperosmolar diabetic coma. Treatment of these dangerous metabolic derangements has to be initiated immediately; blood glucose must, however, not be normalized as rapidly as possible but gradually over 24–36 hours, with close intensive medical monitoring.

DOI: 10.3238/arztebl.m2024.0205

Prof. (i. R.) Dr. med. Ernst-Adolf Chantelau

Bremen

References

1. Weiglein T, Zimmermann M, Niesen WD, Hoffmann F, Klein M: Acute onset of impaired consciousness: diagnostic evaluation in the emergency department. Dtsch Arztebl Int 2024; 121: 508–18

2. Therapie des Typ-1-Diabetes. S3-Leitlinie der Deutschen Diabetes Gesellschaft (DDG) Version 5.1 (2023) AWMF-Registernummer: 057–013 : S. 112–119.