Although the treatment of major emergencies such as profound diabetic coma cannot be standardized, it must be directed by consideration of fundamental principles. The first is that insulin must be given early enough and in sufficient doses to produce the desired effect, regardless of the number of units. The second is that intense dehydration with fall of blood pressure and consequent anuria must be combated by replacement with liquids containing electrolytes in sufficient quantity to restore blood volume and electrolyte balance. A sufficient dose of insulin may be as little as 30 units or it may be from 500 to 1,200 units. The essential thing is that it shall bring about a restoration of normal carbohydrate metabolism as indicated by a falling blood sugar and a rising carbon dioxide combining power of the blood plasma. Patients treated early in the course of coma will require smaller doses; patients treated after
ROOT HF, RISEMAN JEF. THE EXCEPTIONAL REQUIREMENT OF INSULIN AND SALT SOLUTION IN DIABETIC COMA. JAMA. 1938;110(21):1730–1732. doi:10.1001/jama.1938.02790210010004
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