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Coma due to diabetes mellitus

MedGen UID:
226813
•Concept ID:
C1263960
•
Disease or Syndrome
Synonyms: Coma, Diabetic; Comas, Diabetic; Diabetic Coma; Diabetic Comas
SNOMED CT: Coma due to diabetes mellitus (420662003); Diabetic coma (420662003)

Definition

A state of unconsciousness as a complication of diabetes mellitus. It occurs in cases of extreme HYPERGLYCEMIA or extreme HYPOGLYCEMIA as a complication of INSULIN therapy. [from MeSH]

Term Hierarchy

CClinical test,  RResearch test,  OOMIM,  GGeneReviews,  VClinVar  
  • CROGVComa due to diabetes mellitus

Professional guidelines

PubMed

ISPAD clinical practice consensus guidelines 2022: Diabetic ketoacidosis and hyperglycemic hyperosmolar state.
Glaser N, Fritsch M, Priyambada L, Rewers A, Cherubini V, Estrada S, Wolfsdorf JI, Codner E
Pediatr Diabetes 2022 Nov;23(7):835-856. doi: 10.1111/pedi.13406. PMID: 36250645
Management of Hyperglycemic Crises: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State.
Fayfman M, Pasquel FJ, Umpierrez GE
Med Clin North Am 2017 May;101(3):587-606. doi: 10.1016/j.mcna.2016.12.011. PMID: 28372715Free PMC Article
Treatment of Diabetic Ketoacidosis (DKA)/Hyperglycemic Hyperosmolar State (HHS): Novel Advances in the Management of Hyperglycemic Crises (UK Versus USA).
Dhatariya KK, Vellanki P
Curr Diab Rep 2017 May;17(5):33. doi: 10.1007/s11892-017-0857-4. PMID: 28364357Free PMC Article

Recent clinical studies

Etiology

Management of Hyperosmolar Hyperglycaemic State (HHS) in Adults: An updated guideline from the Joint British Diabetes Societies (JBDS) for Inpatient Care Group.
Mustafa OG, Haq M, Dashora U, Castro E, Dhatariya KK; Joint British Diabetes Societies (JBDS) for Inpatient Care Group
Diabet Med 2023 Mar;40(3):e15005. Epub 2022 Dec 21 doi: 10.1111/dme.15005. PMID: 36370077Free PMC Article
Diabetic ketoacidosis fluid management in children: systematic review and meta-analyses.
Hamud AA, Mudawi K, Shamekh A, Kadri A, Powell C, Abdelgadir I
Arch Dis Child 2022 Nov;107(11):1023-1028. Epub 2022 Jun 23 doi: 10.1136/archdischild-2022-324042. PMID: 35738870
Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients.
Karslioglu French E, Donihi AC, Korytkowski MT
BMJ 2019 May 29;365:l1114. doi: 10.1136/bmj.l1114. PMID: 31142480
Evaluation of glycated albumin (GA) and GA/HbA1c ratio for diagnosis of diabetes and glycemic control: A comprehensive review.
Yazdanpanah S, Rabiee M, Tahriri M, Abdolrahim M, Rajab A, Jazayeri HE, Tayebi L
Crit Rev Clin Lab Sci 2017 Jun;54(4):219-232. Epub 2017 Apr 10 doi: 10.1080/10408363.2017.1299684. PMID: 28393586
Hyperglycemic crisis.
Van Ness-Otunnu R, Hack JB
J Emerg Med 2013 Nov;45(5):797-805. Epub 2013 Jun 18 doi: 10.1016/j.jemermed.2013.03.040. PMID: 23786780

Diagnosis

ISPAD clinical practice consensus guidelines 2022: Diabetic ketoacidosis and hyperglycemic hyperosmolar state.
Glaser N, Fritsch M, Priyambada L, Rewers A, Cherubini V, Estrada S, Wolfsdorf JI, Codner E
Pediatr Diabetes 2022 Nov;23(7):835-856. doi: 10.1111/pedi.13406. PMID: 36250645
Management of Hyperglycemic Crises: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State.
Fayfman M, Pasquel FJ, Umpierrez GE
Med Clin North Am 2017 May;101(3):587-606. doi: 10.1016/j.mcna.2016.12.011. PMID: 28372715Free PMC Article
Treatment of Diabetic Ketoacidosis (DKA)/Hyperglycemic Hyperosmolar State (HHS): Novel Advances in the Management of Hyperglycemic Crises (UK Versus USA).
Dhatariya KK, Vellanki P
Curr Diab Rep 2017 May;17(5):33. doi: 10.1007/s11892-017-0857-4. PMID: 28364357Free PMC Article
Diabetic emergencies - ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia.
Umpierrez G, Korytkowski M
Nat Rev Endocrinol 2016 Apr;12(4):222-32. Epub 2016 Feb 19 doi: 10.1038/nrendo.2016.15. PMID: 26893262
Hyperglycemic crisis.
Van Ness-Otunnu R, Hack JB
J Emerg Med 2013 Nov;45(5):797-805. Epub 2013 Jun 18 doi: 10.1016/j.jemermed.2013.03.040. PMID: 23786780

Therapy

Diabetic hyperglycemic emergencies: a systematic approach.
Dingle HE, Slovis C
Emerg Med Pract 2020 Feb;22(2):1-20. Epub 2020 Feb 1 PMID: 31978294
Hyperosmolar Hyperglycemic State.
Stoner GD
Am Fam Physician 2017 Dec 1;96(11):729-736. PMID: 29431405
Management of Hyperglycemic Crises: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State.
Fayfman M, Pasquel FJ, Umpierrez GE
Med Clin North Am 2017 May;101(3):587-606. doi: 10.1016/j.mcna.2016.12.011. PMID: 28372715Free PMC Article
Diabetic emergencies - ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia.
Umpierrez G, Korytkowski M
Nat Rev Endocrinol 2016 Apr;12(4):222-32. Epub 2016 Feb 19 doi: 10.1038/nrendo.2016.15. PMID: 26893262
Hyperglycemic crisis.
Van Ness-Otunnu R, Hack JB
J Emerg Med 2013 Nov;45(5):797-805. Epub 2013 Jun 18 doi: 10.1016/j.jemermed.2013.03.040. PMID: 23786780

Prognosis

Neurological Complications of Endocrine Emergencies.
Cruz-Flores S
Curr Neurol Neurosci Rep 2021 Mar 11;21(5):21. doi: 10.1007/s11910-021-01105-2. PMID: 33709163
Choice of crystalloid fluid in the treatment of hyperglycemic emergencies: a systematic review protocol.
Gershkovich B, English SW, Doyle MA, Menon K, McIntyre L
Syst Rev 2019 Sep 3;8(1):228. doi: 10.1186/s13643-019-1130-5. PMID: 31481108Free PMC Article
Management of Hyperglycemic Crises: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State.
Fayfman M, Pasquel FJ, Umpierrez GE
Med Clin North Am 2017 May;101(3):587-606. doi: 10.1016/j.mcna.2016.12.011. PMID: 28372715Free PMC Article
Diabetic emergencies - ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia.
Umpierrez G, Korytkowski M
Nat Rev Endocrinol 2016 Apr;12(4):222-32. Epub 2016 Feb 19 doi: 10.1038/nrendo.2016.15. PMID: 26893262
Hyperosmolar hyperglycemic state: a historic review of the clinical presentation, diagnosis, and treatment.
Pasquel FJ, Umpierrez GE
Diabetes Care 2014 Nov;37(11):3124-31. doi: 10.2337/dc14-0984. PMID: 25342831Free PMC Article

Clinical prediction guides

Severe Hypoglycemia: Is It Still a Threat for Children and Adolescents With Type 1 Diabetes?
Urakami T
Front Endocrinol (Lausanne) 2020;11:609. Epub 2020 Sep 15 doi: 10.3389/fendo.2020.00609. PMID: 33042005Free PMC Article
Hypertension during Diabetic Ketoacidosis in Children.
DePiero A, Kuppermann N, Brown KM, Schunk JE, McManemy JK, Rewers A, Stoner MJ, Tzimenatos L, Garro A, Myers SR, Quayle KS, Trainor JL, Kwok MY, Nigrovic LE, Olsen CS, Casper TC, Ghetti S, Glaser NS; Pediatric Emergency Care Applied Research Network (PECARN) DKA FLUID Study Group
J Pediatr 2020 Aug;223:156-163.e5. Epub 2020 May 6 doi: 10.1016/j.jpeds.2020.04.066. PMID: 32387716Free PMC Article
Clinical Outcomes in Patients With Isolated or Combined Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State: A Retrospective, Hospital-Based Cohort Study.
Pasquel FJ, Tsegka K, Wang H, Cardona S, Galindo RJ, Fayfman M, Davis G, Vellanki P, Migdal A, Gujral U, Narayan KMV, Umpierrez GE
Diabetes Care 2020 Feb;43(2):349-357. Epub 2019 Nov 8 doi: 10.2337/dc19-1168. PMID: 31704689Free PMC Article
Choice of crystalloid fluid in the treatment of hyperglycemic emergencies: a systematic review protocol.
Gershkovich B, English SW, Doyle MA, Menon K, McIntyre L
Syst Rev 2019 Sep 3;8(1):228. doi: 10.1186/s13643-019-1130-5. PMID: 31481108Free PMC Article
Clinical Trial of Fluid Infusion Rates for Pediatric Diabetic Ketoacidosis.
Kuppermann N, Ghetti S, Schunk JE, Stoner MJ, Rewers A, McManemy JK, Myers SR, Nigrovic LE, Garro A, Brown KM, Quayle KS, Trainor JL, Tzimenatos L, Bennett JE, DePiero AD, Kwok MY, Perry CS 3rd, Olsen CS, Casper TC, Dean JM, Glaser NS; PECARN DKA FLUID Study Group
N Engl J Med 2018 Jun 14;378(24):2275-2287. doi: 10.1056/NEJMoa1716816. PMID: 29897851Free PMC Article

Recent systematic reviews

Combined diabetic ketoacidosis and hyperosmolar hyperglycemic state in type 1 diabetes mellitus induced by immune checkpoint inhibitors: Underrecognized and underreported emergency in ICIs-DM.
Zhang W, Chen J, Bi J, Ding N, Chen X, Wang Z, Jiao Y
Front Endocrinol (Lausanne) 2022;13:1084441. Epub 2023 Jan 4 doi: 10.3389/fendo.2022.1084441. PMID: 36686495Free PMC Article
PD-1 inhibitor-associated type 1 diabetes: A case report and systematic review.
Lin C, Li X, Qiu Y, Chen Z, Liu J
Front Public Health 2022;10:885001. Epub 2022 Aug 5 doi: 10.3389/fpubh.2022.885001. PMID: 35991054Free PMC Article
Diabetic ketoacidosis fluid management in children: systematic review and meta-analyses.
Hamud AA, Mudawi K, Shamekh A, Kadri A, Powell C, Abdelgadir I
Arch Dis Child 2022 Nov;107(11):1023-1028. Epub 2022 Jun 23 doi: 10.1136/archdischild-2022-324042. PMID: 35738870
Acute kidney injury in trauma patients admitted to the ICU: a systematic review and meta-analysis.
Søvik S, Isachsen MS, Nordhuus KM, Tveiten CK, Eken T, Sunde K, Brurberg KG, Beitland S
Intensive Care Med 2019 Apr;45(4):407-419. Epub 2019 Feb 6 doi: 10.1007/s00134-019-05535-y. PMID: 30725141
Diabetes during diarrhea-associated hemolytic uremic syndrome: a systematic review and meta-analysis.
Suri RS, Clark WF, Barrowman N, Mahon JL, Thiessen-Philbrook HR, Rosas-Arellano MP, Zarnke K, Garland JS, Garg AX
Diabetes Care 2005 Oct;28(10):2556-62. doi: 10.2337/diacare.28.10.2556. PMID: 16186301

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