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DKA and not respondin after medically induced coma
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DKA and not respondin after medically induced coma

I have a question about my mother in law. She was found Saturday morning by her husband, in bed, with her eyes glazed over. When he tried to talk to her she was incoherent and he couldn't get her up so he called an ambulance. They checked her blood sugar and it was 1800!! She did not even know she had diabetes. She had been feeling like she had the flu for a few days preceding this. They are not sure as of right now if she has type 1 or 2 diabetes. They put her in a medically induced coma to bring her blood sugar down and by Sunday it was down to 110. Since her blood sugar was down, they wanted to bring her out of the coma and get the tube out of her throat, but when they tried to bring her out, she was not responding properly. She did "wake up" and was struggling and very obviously not comfortable, but she did not respond to anyone by following instruction or making meaningful eye contact. They decided to put her back under and do a CT. CT came back normal but they did some labs and her sodium was high so they decided to flush her blood and try to bring her out on today. Well today her sodium is down (still elevated but better) and I know that high sodium levels can cause the brain cells to be lacking water and therefore can cause confusion, but they are thinking it is low enough that this shouldn't be the issue now. They tried to bring her back out today, but she did the same thing. She was very restless and trying to sit up and trying to move about, but she wasn't actually making contact with anyone. They turned the tube off and she is breathing on her own now but obviously they can't take te tube out in case something else happens. They are going to do an EKG to check her brain activity this afternoon.  Also when she was admitted, she had a fever of 103 and she has been on antibiotics since then and today her temp is 101. Does anyone have any ideas as to what might be going on? What could be keeping her stuck in a semi-unconcious state? I hate to think that she is trapped in there struggling but unable to cognitively communicate. Any ideas are appreciated.
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Avatar_m_tn
I am so sorry to hear about your mother-in-law.  Talk with the care givers and ask them what is causing the decreased level of consciousness. They should be able to give you some ideas.

Here are my ideas:

For your mother-in-law to have such a high glucose, she had to have been very dehydrated. This might be the reason for her initial temperature of 103. But, it is also very likely that she aspirated while she was comatose/decreased level of consciousness at home and has a lung infection. Did she have cultures on admission? Since her temperature is still elevated, she should have repeat cultures to identify an infection. Ask her caregivers. She needs to have had cultures of blood, urine, and sputum plus a check for any areas of infection - they have her on antibiotics - but did they actually identify a location or organism? Look her over and see if you see any areas of redness or drainage.

She has had massive shifts in her electrolytes - sodium, potassium, and chloride. Plus, with the rehydration, all of this is can cause cerebral edema. I know you said she had a normal CT - that should have picked up cerebral edema - but this still sounds like cerebral edema. Does she have a neurologist?  I would think so since they are doing an EEG. Ask to speak to her neurologist.

Did she have any times when she wasn't breathing or her oxygen level was low?

She would have had a severe acid-base imbalance - this can take a bit to recover from. Maybe she just needs some more time.

I hope by the time you read my response, your mother-in-law has improved. Sometimes, it just takes time for the brain to recover.
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Avatar_m_tn
Thanks a lot for your response. She is actually doing a lot better now. She was responding to nurses this morning so they took her breathing tube out and she was talking. She has since eaten ice chips and applesauce which is awesome. PT came in and had her standing on her own. Her sodium is still high so that may still be causing some confusion as she is still very moody and angry and I don't think she is fully understanding what is going on yet but she remembers everyone and asks for things, she just gets mad when she can't have things and quickly. Hopefully it is just taking some time for the fog to lift.
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Avatar_m_tn
Glad to hear. Sounds like she is recovering. Just give her some more time and don't worry about the anger and such - her brain still has a way to go to fully recover. She has had a really rough time of it - and I bet her family has too!
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Avatar_m_tn
How is your mother in law doing,  My good friend has just been hopitalized blood sugar 1,800 they put her in a induced coma. She is in crital condition. She has been a diabetic 1 forever.  She is 60 yers old.  I am afraid for her.  They have her sugar down to 400 since this all hapened about 14 hours ago.  400 blood sugar for her is normal.  Please share anything you can.  Thank you
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