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Coma diabeticum

Management der diabetischen Ketoazidose und des nicht ketoazidotischen hyperosmolaren Komas

  • Schwerpunkt: Endokrine und metabolische Krisen
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Zusammenfassung

In der Arbeit werden die Behandlungsprinzipien des ketoazidotischen und des hyperosmolalen diabetischen Komas dargestellt. Die Zusammenfassung berücksichtigt die aktuellen Leitlinien der Deutschen Diabetes-Gesellschaft zu diesem Thema und diskutiert insbesondere die bei der Erstbehandlung und auf der Intensivstation durchzuführenden Maßnahmen der Volumen- und Insulintherapie, sowie des Kaliumersatzes. Besonderer Wert wird dabei auf die Darstellung der Grundlagen gelegt, die dem heutigen Konzept der niedrig dosierten Insulintherapie zur Vermeidung eines Disäquilibriumsyndroms zugrunde liegen. Ferner werden die Indikationen zur Bikarbonattherapie kritisch diskutiert.

Mit den heute zur Verfügung stehenden Möglichkeiten kann das Therapieziel einer geringen Mortalität, abhängig von der dem Koma zugrundeliegenden Ursache, erreicht werden.

Abstract

This review describes the current guidelines of the German diabetes association for the management of diabetic coma, both of diabetic ketoacidosis and hyperosmolal coma. The outline focuses on emergency treatment and the management on the intensive care unit, in particular, volume and insulin therapy, and potassium replacement. The delineation of the concept of low insulin therapy is emphazised to avoid the incidence of disequilibrium syndrome. Also, the indications for bicarbonate therapy in diabetic ketoacidosis are critically discussed, as well as phosphate and magnesium replacement.

With today's therapeutic possibilities the therapeutic goal, i.e. a low mortality, may be achieved, dependent on the underlying illness.

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Danksagung.

Ich bedanke mich herzlich bei Herrn Ltd. OA Dr. W. Worthmann für die hilfreiche Diskussion und die kritische Durchsicht des Manuskripts sowie bei Frau Mechthild Krumnack für die Unterstützung bei der Erstellung des Manuskripts.

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Hensen, J. Coma diabeticum. Internist 44, 1260–1274 (2003). https://doi.org/10.1007/s00108-003-1058-6

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  • DOI: https://doi.org/10.1007/s00108-003-1058-6

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