Coma ipoglicemico
Definizione
Il coma ipoglicemico dovrebbe essere sospettato in tutti i pazienti con alterazioni dello stato di coscienza. Episodi ipoglicemici che possono progredire verso il coma ipoglicemico sono una delle complicanze acute più frequenti nei pazienti diabetici in terapia insulinica.
Trattamento
L’obiettivo terapeutico consiste nel riportare la glicemia nei livelli di norma più rapidamente possibile. Se il paziente è parzialmente cosciente e in grado di deglutire, alimenti contenenti glucosio, come dolci, succo d’arancia zuccherato, dovrebbero essere assunti rapidamente. Una dose iniziale ragionevoli è di circa 20 g di glucosio. Il fruttosio, contenuto in molti alimenti ipocalorici per i diabetici non è utile in quanto anche se può essere metabolizzato dai neuronni attraversa la barriera ematoencefalica. Se il paziente è incosciente, è necessario somministrare per via endovenosa 20-25 ml di glucosio al 50% in 1-3 minuti, quando il glucosio endovena non è disponibile 1 mg di glucagone per via intramuscolo o endovena. La somministrazione di glucagone solitamente ripristina lo stato coscienza in 10-15 minuti. Si dovrebbero evitare tentativi di alimentare il paziente a causa del pericolo di polmonite ab ingestis. Appena il paziente riprende lo stato di coscienza, è indicato il ritorno all’ alimentazione per os appena possibile. La glicemia deve essere monitorata per il periodo successivo 12-24 ore per verificare l’euglicemia stabile​.
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