The latest cerebrovascular insult predictor to hyperosmolar coma

The aim of the work is to present the way how the latest insult might cause hyperosmolar coma. Case report: About 10 o'clock a.m. the dispatcher received a call by the police who having broken into the apartment found N.M. 73, in the unconscious state. On coming to the case spot the emergency aid team found the patient on the floor unconscious with vomited content on the dress and carpet, urinated. From the heteroanaemnesis (taken from a nearby merchant): the woman was on her own, and the last time seen in the grocery two days before. From the status: The patient was in a deep comatose state, did not react to tough stimulations, febrilous, with her tongue extremely dry, coated with brownish layers, the skin also dry. Cor: heart beating rhythmical, tachycardiac, tones lower, slight systolic murmur above ictus, frequency 150/min, TA unmesaurable. Pulmo: airways murmor normal. Other findings insignificant. Glucose highly unmeasurable on the glucometer. The tablets of glibenklamid, metformin and lizinopril were found on the dresser. The venuous ways were hardly open, and cardiotonic, physiological solution was given immediately on the spot and after that the patient was transported to to the clinic. In the course of the transportation, another venuous way was open, included physiological solution with 10 I.J. of efficient insuline. On arriving to the clinic, the next laboratory fin-dinggs were carried out within the intensive care unit: On 157:K 5,4: GUK 104 mmol/l: urea 28,0: creatinine 206: ABS: normal. The therapy at the clinic: fractioned 4 x s.c. effective insuline, hypotonic solution of natrium chloride with effective insuline, cardiotonic, wide spectrum antibiotic. After 48 hours, glycaemia stable, from 9,8 to 14,5:Na 147:K 4,2: urea 9,8: creatinine 123, the patient conscious, somnolent, does not speak with a right hemiplegia. An urgent head CT is done with the evidence of fresh lesion on the left parietally. .