It is one of the severe acute complications of diabetes, characterized by extremely high blood sugar without significant ketoacidosis, dehydration, increased plasma osmotic pressure, progressive consciousness impairment, and a high mortality rate. The prognosis depends on the patient's age and the severity of the condition, but more importantly on timely diagnosis and appropriate treatment.

bubble_chart Diagnosis

1. Medical History and Symptoms:

More common in the elderly, may have no history of diabetes. Precipitating factors can include infection, intravenous glucose infusion, use of diuretics, glucocorticoids, etc. Symptoms include thirst, polydipsia, and polyuria for several days or weeks, gradually progressing to neurological and psychiatric symptoms such as dysphoria, drowsiness, disorientation, and even unconsciousness.

2. Physical Examination Findings:

Altered mental status, such as dysphoria, drowsiness, disorientation, or even unconsciousness; marked signs of dehydration, decreased blood pressure, and positive pathological reflexes.

3. Auxiliary Examinations:

Hyperglycemia >33.3 mmol/L; effective plasma osmolality >320 mOsm/L [a rough calculation of effective plasma osmolality = 2(Na ⁺ K) + blood glucose, in mmol/L]; urine ketones (-) or (+)-(++).

4. Differential Diagnosis:

Should be distinguished from other causes of unconsciousness.

bubble_chart Treatment Measures

Immediate treatment should be provided in the emergency room, and admission to the ward or ICU is recommended if the patient's condition allows.

I. Active fluid replacement:

For patients in shock, administer normal saline and colloid solutions (such as plasma) first to correct shock as quickly as possible. For patients without shock or whose shock has been corrected, if plasma osmolality >350 mOsm/L, 0.45% hypotonic sodium chloride solution can be infused under close monitoring. When plasma osmolality drops to 330 mOsm/L, switch back to isotonic solutions.

Administer 2–6 U/h via intravenous drip to gradually lower blood glucose levels, preventing excessive drops that may lead to cerebral edema. When blood glucose drops to 16.7 mmol/L, switch to 5% glucose solution with insulin at a ratio of insulin:glucose = 1 U:3–4 g.

III. Maintain electrolyte balance:

Serum potassium <5mmol即開始補鉀,使血鉀維持於4～5mmol/L。

IV. Address the underlying causes and closely monitor vital signs, blood and urine glucose, electrolytes, BUN, etc.