Prolonged hypoglycaemia coma caused by diabetic nephropathy

The goal of the work is to demonstrate the way of controlling kidney function with patients suffering from diabetes and to harmonise the medicament dosage with the emphasis on elimination and semi-existence of the same one. A fifty-year-old patient was admitted to the clinic in a state of deep coma. The team of Emergency Aid Department applied the ampulla of glucogen i.m. and 50ml of glucose i.v., due to GUK being registered at 2,1 mmol/l. After the therapy treatment GUK was 7,9 mmol/l but the patient was still in unconscious state. The patient being suspected of insult, was immediately sent to the clinic. After having been admitted at the Health Emergency Department, GUK was recognised at 1,9 and another 50 ml 50% of glucose was applied with the patient. Since the patient could not regain cosciousness, he was sent to the clinic. The patient had been found by his spouse. The patient has suffered from diabetes for 15 years. Glibenclamid had been randomly taken by the patient (1-4 pills a day), depending on what he ate, having been hypertronic for about ten years, not regularly taking enalapril pills, an alcohol consumer. This patient had not had a proper check-up for 5 years, since having been retired. The spouse noticed the patient's legs, hands and face swelling followed by being sick, lack of appetite and vomiting. Referring to status: the patient is in deep coma, does not react to external stimuli, his respiration is deep, and face yellowish. Conspicuous water oedema is visible on hands, legs with aescites, frequency 80/min, TA 145/95mm Hg., other analysis insignificant. The urgent laboratory analyses were carried out, the neurologist was summoned. GUK was checked by means of glucometer with the result: 6,5l/L. Taking all implications into consideration, the patient is suspected of prolonged hypogycaemia and brain oedema. 50% glucose was given in continuation i.v. After 220ml 50% glucose, the depth of respiration altered and after another 30ml, the patient regained consciousness, stood up and wondered what had happened. Referring to the laboratory results: GUK 6,0: urea 29,5: creatinin 565: at 134:K 5,9. The patient was treated by intensive diuretic therapy followed by infusion 5% glucose. In the course of the next 4 days the patient experienced shallow and short term hypoglycaemic coma and with applying 20-40ml 50% glucose he regained consciousness. Before being admitted to hospital he had taken 4 pills of glibenclamid since he had lunch and the next morning he took 2 pills and did not remember having breakfast. People suffering from diabetes are supposed to be regularly checked by practitioners GUK monthly, postprandially. Hemoglobin is supposed to be checked at least once in the period of 3 months. Kidney function is supposed to be checked once in six months or more frequently, if needed. The prospective complications are to be followed with the emphasis on certain organs, the diet is supposed to be strictly controlled. The doctors are to estimate giving the adequate medicine (dosage). Furthermore, the patients are to be continually educated so as to be fully aware of how to prevent later diabetes complications. .