Coagulation abnormalities in diabetic coma before and 24 hours after treatment

Area of Science:

• Clinical Medicine
• Hematology
• Endocrinology

Background:

• Acute diabetic metabolic decompensation can lead to significant physiological disturbances.
• Coagulation system alterations are increasingly recognized in critically ill patients with metabolic disorders.

Purpose of the Study:

• To investigate the prevalence and nature of coagulation abnormalities in patients with impaired consciousness due to acute diabetic metabolic decompensation.
• To assess changes in coagulation parameters following initial treatment.

Main Methods:

• A comprehensive coagulation screen was performed on 24 patients at admission and 24 hours later.
• Tests included prothrombin time, thrombin time, kaolin cephalin clotting time, platelet count, plasma fibrinogen, fibrin degradation products, and ethanol gelation test.
• Patients were categorized based on the number of coagulation abnormalities and clinical outcomes.

Main Results:

• 22 of 24 patients exhibited at least one coagulation abnormality on admission; common findings were prolonged prothrombin time, shortened kaolin cephalin clotting time, and raised plasma fibrinogen.
• After 24 hours of treatment, coagulation parameters showed improvement, yet 20 of 22 patients still had abnormalities.
• 15 patients had two or more abnormalities, with 3 showing signs of disseminated intravascular coagulation. Patients with multiple abnormalities were older and had higher blood urea levels.

Conclusions:

• Coagulopathy is a common finding in patients with impaired consciousness from acute diabetic metabolic decompensation.
• While treatment can normalize some coagulation parameters, persistent abnormalities are frequent.
• Multiple coagulation abnormalities at admission may be associated with poorer outcomes, including hyperosmolar non-ketotic coma and mortality.