Emergency Protocol for Hyperglycemic Coma: A Comprehensive Guide

Hyperglycemic coma is a severe acute complication of diabetes that requires immediate medical attention. When a patient experiences such a condition, it is crucial to follow a structured emergency protocol to stabilize their health and prevent further complications.

Step 1: Rapid Glycemic Control

Administer short-acting insulin to effectively lower blood glucose levels. The target rate of glucose reduction should be between 2.75–3.9 mmol/L per hour. Continuous intravenous insulin infusion is often the preferred method, allowing for precise dosage adjustments based on frequent blood glucose monitoring.

Step 2: Aggressive Fluid Replacement

Patients typically experience severe dehydration due to elevated plasma osmolality. The first-line fluid for rehydration is isotonic saline (0.9% NaCl), administered rapidly at the initial stage, followed by a slower infusion rate as the patient stabilizes.

If plasma osmolality remains above 320 mOsm/kg or serum sodium exceeds 155 mmol/L, hypotonic saline (0.45% NaCl) may be introduced to help restore fluid balance. Once blood glucose levels drop below 16.7 mmol/L, the IV solution can be switched to 5% dextrose with added insulin to maintain glycemic control while preventing hypoglycemia.

Step 3: Electrolyte Management

Potassium Replacement

As insulin therapy and fluid replacement progress, patients often develop hypokalemia. Potassium supplementation should be initiated if serum potassium is below 5.5 mmol/L and the patient is producing urine. Close monitoring is essential to avoid overcorrection and potential cardiac complications.

Step 4: Correction of Metabolic Acidosis

In cases where pH falls below 7.1, serum bicarbonate drops under 5 mmol/L, or CO₂ combining power is less than 10 mmol/L, administration of isotonic sodium bicarbonate solution is indicated. This intervention should be done cautiously, with ongoing assessment of acid-base status.

Addressing Underlying Triggers

While immediate stabilization is vital, it is equally important to identify and treat underlying causes such as infections, trauma, or other stress-inducing conditions. Failure to address these triggers may lead to recurrence or prolonged metabolic instability.

Timely diagnosis, structured intervention, and comprehensive post-stabilization care are key to improving outcomes in patients experiencing hyperglycemic coma. Healthcare providers should maintain a high index of suspicion and act swiftly to ensure optimal recovery.