Summary
A coagulation screen consisting of measurement of the prothrombin time, thrombin time, kaolin cephalin clotting time, platelet count, plasma fibrinogen level, fibrin degradation products and ethanol gelation test was performed on 24 patients with impairment of consciousness due to acute diabetic metabolic decompensation at the start of treatment and 24 hours later. 22 out of 24 patients showed at least one coagulation abnormality on admission of which the commonest were a prolonged prothrombin time, shortened kaolin cephalin clotting time and raised plasma fibrinogen level. After 24 hours of treatment these values were more normal but 20 out of 22 patients still displayed some abnormality. 15 patients had two or more coagulation abnormalities on admission including 3 patients with haematological abnormalities suggestive of disseminated intravascular coagulation. This group was older and had higher blood ureas than those with fewer abnormalities, but plasma glucose, sodium, potassium and bicarbonate levels were similar in both groups of patients. All 5 patients with hyperosmolar non-ketotic coma and all 3 patients who died without recovering consciousness had two or more coagulation abnormalities on admission.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Guisado, R., Arieff, A. I.: Neurological manifestations of diabetic coma. Metabolism24, 665–679 (1975)
Timperley, W. R., Preston, F. E., Ward, J. D.: Cerebral intravascular coagulation in diabetic ketoacidosis. Lancet1974 I, 952–956
Egeberg, O.: The blood coagulability in diabetic patients. Scand. J. Clin. Lab. Invest.15, 533–538 (1963)
Mayne, E. E., Bridges, J. M., Weaver, J. A.: Platelet adhesiveness, plasma fibrinogen and factor VIII levels in diabetes mellitus. Diabetologia6, 436–440 (1970)
Kwaan, H. C., Colwell, J. A., Suwanwela, N.: Disseminated intravascular coagulation in diabetes mellitus with reference to the role of increased platelet aggregation. Diabetes21, 108–113 (1972)
Nicholson, G., Tomkin, G. H.: Successful treatment of disseminated intravascular coagulopathy complicating diabetic coma. Br. Med. J.1974 IV, 450
Bellet, S., Sandber, H., Tsitouris, G., Muller, O., Schraeder, J.: Alteration in fibrinolytic parameters during recovery from diabetic acidosis. Metabolism10, 429–438 (1961)
Dacie, J. V., Lewis, S. M.: Practical haematology. 5th ed., pp 314–403. London: Churchill 1975
Biggs, R., Denson, K. W. E.: Standardisation of the one-stage prothrombin time for control of anticoagulant therapy. Br. Med. J.1967 I, 84–88
Ellis, B. C., Stransky, A.: A quick and accurate method for the determination of fibrinogen in plasma. J. Lab. Clin. Med.58, 477–488 (1961)
Burmester, H. B. C., Aulton, K., Horsfield, G. I.: Evaluation of a rapid method for the determination of plasma fibrinogen. J. Clin. Pathol.23, 43–46 (1970)
Ghanem, M. H., Tawfik, S., Guirgis, F. K.: Correlative study of blood coagulation and lipids in uncomplicated diabetes mellitus. Atherosclerosis14, 271–281 (1971)
MacCuish, A. C.: In: Recent advances in intensive therapy. Ledingham, I. M. (ed.), Chapter 9: Diabetic hyperosmolar states, pp 107–124. Edinburgh: Churchill Livingstone 1977
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
McLaren, E.H., Cullen, D.R. & Brown, M.J. Coagulation abnormalities in diabetic coma before and 24 hours after treatment. Diabetologia 17, 345–349 (1979). https://doi.org/10.1007/BF01236267
Received:
Revised:
Issue Date:
DOI: https://doi.org/10.1007/BF01236267