[Coma and praecoma diabeticum. Physiopathology, clinical aspects and therapy]

The diabetic coma is characterized by fundamental metabolic changes. Apart from the hyperglycaemia, exsiccosis and the disturbed electrolyte metabolism are considerable factors contributing to the coma. The treatment of diabetic coma puts great demands on the doctors, since the prognosis can only be improved by systematic and correct intervention. A fast filling up of the volume and a specific electrolyte (potassium) substitution are very important. In cases of ketoacidotic diabetic coma the acidosis must be carefully balanced, whereby the "rest-acidosis" up to pH 7.1 can be tolerated. The administration of insulin can only begin, when the volume and electrolyte substitution is guaranteed, otherwise dangerous insulin-induced hypokalaemia is unavoidable. By no means may the first treatment for the insulinisation be carried out ambulatory.