Diabetisches Koma

Kernaussagen

• Aufgrund der zunehmenden Bedeutung des Diabetes mellitus sind eine strukturierte Diagnostik und Therapie von Diabeteskomplikationen in der Intensivmedizin von großer klinischer Bedeutung, um die Mortalität der Patienten zu senken und erneute Episoden zu vermeiden. Hierfür gibt es Leitlinien mit Empfehlungen hoher Evidenz [8] [26].

• Grundsätzlich sollte für hyperglykäme Entgleisungen wie die diabetische Ketoazidose und das hyperglykäme hyperosmolare Syndrom an jedem Krankenhaus individuell ein an diesen Leitlinien orientierter Therapiealgorithmus definiert werden.

• Bei der diabetischen Ketoazidose und dem hyperglykämen hyperosmolaren Syndrom kommt es durch osmotische Diurese zu Exsikkose und Elektrolytverlust, deren Behandlung neben der Senkung des Blutzuckerspiegels mit Insulin vorrangig ist.

• Die Verabreichung von Phosphat und Bikarbonat soll aufgrund fehlender Evidenz eines positiven Nutzens und wegen des potenziellen Schadens nur in Ausnahmefällen erfolgen.

• Die Hypoglykämie ist nicht über einen einheitlichen Blutglukosewert definiert. Vielmehr sind neben einem niedrigen Messwert die typische Symptomatik und Fähigkeit zur Selbsttherapie ausschlaggebend für die Einteilung in eine milde oder schwere Form.

• Die Identifizierung von Risikofaktoren für diabetische Komplikationen ermöglicht gezielte individuelle Interventionen und Schulungsprogramme (z. B. Hypoglykämiewahrnehmungstraining).

• Unabhängig vom Diabetes mellitus gibt es eine Assoziation zwischen dem Auftreten von Hypoglykämien und der Mortalität von Intensivpatienten, weshalb man bei schwer Erkrankten lediglich einen Blutzuckerwert von unter 10 mmol/l (180 mg/dl) anstreben sollte [31].

• Literatur

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