In the treatment of diabetic coma several potentially avoidable complications can appear (Table 7). In particular, syndrome disequilibrium associated with cerebral edema is caused by an overly rapid fall of osmolality, especially by hypotonic solutions and inadequate bicarbonate therapy. Hypernatremia and hyperchloremia can be induced by excessive infusion of sodium chloride, especially with decreased renal function and infusion of sodium bicarbonate. If there is a lack of monitoring of central venous pressure, volume therapy can lead to pulmonary edema. Over dosage of bicarbonate can induce paradoxical acidosis of the central nervous system. Hypokalemia appears frequently after rapid application of a high insulin dose and inadequate potassium substitution. Phosphate depletion in disturbed renal function and lack of balance can lead to individual problems and hypocalcemia can be the consequence of a high phosphate substitution. High insulin replacement increases the risk of disequilibrium syndrome and hypoglycemia. In addition, complicating factors are throm-boembolic events like myocardial, cerebral, and mesenteric infarction. This can be compounded by cardiopulmonary complications with cardiovascular shock and adult respiratory distress syndrome, as well as by severe thyrotoxicosis.
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