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Zahran NA, Jadidi S. Pediatric Hyperglycemic Hyperosmolar Syndrome: A Comprehensive Approach to Diagnosis, Management, and Complications Utilizing Novel Summarizing Acronyms. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1773. [PMID: 38002864 PMCID: PMC10670661 DOI: 10.3390/children10111773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 11/26/2023]
Abstract
This paper focuses on hyperglycemic hyperosmolar syndrome (HHS), a unique hyperglycemic state requiring divergent diagnosis and treatment approaches from diabetic ketoacidosis (DKA) despite some shared characteristics. We introduce the mnemonic DI-FF-ER-EN-CE-S to encapsulate unique HHS management and complications. 'DI' emphasizes the need to delay and decrease initial insulin therapy until serum glucose decline is managed by fluid resuscitation alone. 'FF' stresses the importance of double fluid replacement compared to DKA due to severe dehydration and 'ER' electrolyte replacement due to profound losses and imbalances. 'EN' denotes the potential for encephalopathy and the requirement for a controlled serum osmolality reduction. 'CE' indicates cerebral edema, a rare complication in HHS. 'S' signifies systemic multiorgan failure. We categorize the associated risks into three mnemonic groups: the 3Rs (renal failure, respiratory distress, rhabdomyolysis), the 3Hs (heart failure, hypercoagulation, hyperthermia), and AP (arrhythmias, pancreatitis) to facilitate awareness and screening of HHS.
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Affiliation(s)
- Naser Amin Zahran
- Lurie Children’s at Northwestern Medicine Central DuPage Hospital, Winfield, IL 60190, USA;
| | - Shaheen Jadidi
- Loyola University Medical Center, Maywood, IL 60153, USA
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Shaka H, El-Amir Z, Wani F, Albosta M, Dahiya DS, Alabi O, Muojieje CC, Kichloo A. Hospitalizations and inpatient mortality for hyperosmolar hyperglycemic state over a decade. Diabetes Res Clin Pract 2022; 185:109230. [PMID: 35122906 DOI: 10.1016/j.diabres.2022.109230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 12/29/2021] [Accepted: 01/31/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVES This study aimed to describe rates and trends in hospitalizations, inpatient mortality, total hospital charges, and mean lengths of stay among adult patients hospitalized for hyperosmolar hyperglycemic state (HHS). METHODS The study included NIS databases 2008, 2010, 2012, 2014, 2016, and 2018. These databases were searched for hospitalizations with a principal discharge diagnosis of HHS in patients with T2DM using ICD codes (25020, 25022, and E110). Patients less than 18 years, elective hospitalizations, HHS in patients with T1DM or secondary diabetes mellitus were excluded. We used multivariable regression analysis to obtain trends in mortality, length of stay (LOS), and total hospital charges (THC). RESULTS Between 2008 and 2018, there was a trend towards increasing hospitalizations for T2DM with HHS (p trend < 0.001). The mean age over the period ranged from 56.9 to 59.1 years old. Men made up the majority of hospitalizations. Over the decade, there was a steady rise in the proportion of Whites and Hispanics with HHS, and Medicare was the most prevalent insurer overall. Inpatient mortality for HHS decreased from 1.44% in 2008 to 0.77% in 2018 (p trend 0.007). There was also a statistically significant decrease in both LOS and THC over the studied period. CONCLUSIONS Trends in HHS showed increased hospitalizations, LOS, and THC over the decade in the study period, but inpatient mortality declined.
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Affiliation(s)
- Hafeez Shaka
- Department of Internal Medicine, John H. Stroger Jr. Hospital, Chicago, IL, USA.
| | - Zain El-Amir
- Department of Internal Medicine, Central Michigan University, Saginaw, MI, USA
| | - Farah Wani
- Department of Medicine, Samaritan Medical Center, Watertown, NY, USA
| | - Michael Albosta
- Department of Internal Medicine, Central Michigan University, Saginaw, MI, USA
| | | | - Omolabake Alabi
- Department of Internal Medicine, Jacobi Medical Center, NY, USA
| | | | - Asim Kichloo
- Department of Internal Medicine, Central Michigan University, Saginaw, MI, USA; Department of Medicine, Samaritan Medical Center, Watertown, NY, USA
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Pierce KN, Lee S, Pacheco R, Sadar MJ. Hyperglycemic hyperosmolar syndrome in a domestic ferret (Mustela putorius furo) following a partial pancreatectomy. J Exot Pet Med 2020. [DOI: 10.1053/j.jepm.2020.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Unresponsive: A Case of Hyperglycemia and Altered Mental Status. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2019. [DOI: 10.1016/j.cpem.2019.100726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Reddy A, Finley L, Horrall S. Hyperosmolar hyperglycemic syndrome in a young boy. Proc (Bayl Univ Med Cent) 2019; 32:627-628. [PMID: 31656445 DOI: 10.1080/08998280.2019.1646598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 07/10/2019] [Accepted: 07/18/2019] [Indexed: 01/11/2023] Open
Abstract
We describe a 6-year-old boy who presented to the emergency department with the complaint of nausea and vomiting with diarrhea. Workup revealed a glucose level of 1904 mg/dL, and hyperglycemic hyperosmolar syndrome was diagnosed. Hyperglycemic hyperosmolar syndrome is very rare in the pediatric population, but recent published reports suggest that the incidence of this disorder may be increasing.
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Affiliation(s)
- Archana Reddy
- College of Medicine, Texas A&M Health Science CenterTempleTexas
| | - Leland Finley
- Department of Emergency Medicine, Baylor Scott & White Medical Center-TempleTempleTexas
| | - Shawn Horrall
- Department of Emergency Medicine, Baylor Scott & White Medical Center-TempleTempleTexas
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Al Hazmi A, Manning S. Limb Ischemia in a Patient with Hyperosmolar Hyperglycemic State. Clin Pract Cases Emerg Med 2018; 2:348-352. [PMID: 30443624 PMCID: PMC6230346 DOI: 10.5811/cpcem.2018.9.39920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 09/04/2018] [Accepted: 09/07/2018] [Indexed: 12/02/2022] Open
Abstract
A 61-year-old male with a recent diagnosis of pemphigus vulgaris was brought to the emergency department for altered mental status. He had recently started taking prednisone to manage his autoimmune disease and had a progressive decline in his mental status along with decreased oral intake. Evaluation revealed hyperosmolar hyperglycemic state (HHS) and occlusive arterial thrombosis, a rare but known complication of HHS. He was resuscitated aggressively with intravenous fluids, insulin, and heparin and admitted to the intensive care unit. Emergency physicians should remain vigilant for ischemic complications in patients with HHS. Early recognition and treatment can reduce the morbidity and mortality associated with this endocrine emergency.
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Affiliation(s)
- Ahmed Al Hazmi
- University of Maryland Medical Center, Department of Emergency Medicine, Baltimore, Maryland
| | - Sara Manning
- University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
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Jansson PS, Kabrhel C, Miller ES. Altered Mental Status in an Elderly Male. J Emerg Med 2018; 54:232-237. [PMID: 29242011 DOI: 10.1016/j.jemermed.2017.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 11/18/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Paul S Jansson
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Christopher Kabrhel
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Emily S Miller
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
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Zuccarelli BD, Hall AS. Utility of Obtaining a Serum Basic Metabolic Panel in the Setting of a First-Time Nonfebrile Seizure. Clin Pediatr (Phila) 2016; 55:650-3. [PMID: 26810624 DOI: 10.1177/0009922815627422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
New-onset nonfebrile seizures in an otherwise healthy child are common, affecting 25 000 to 40 000 U.S. children annually. We hypothesized seizure-provoking electrolyte disturbances such as hyponatremia, hypoglycemia, and hypocalcemia are uncommon in these children. From January 1, 2009 to May 31, 2009, 358 children aged 29 days to 18 years with a diagnosis code of 780.39 ("other convulsions" including "first time seizure," etc) were included for potential retrospective review. Children with known epilepsy and febrile seizures were excluded. Electrolytes were obtained in nearly all children with a history suggestive of an underlying abnormality (13 of 14, 93%) but also in half of children with a reassuring history (62 of 119, 52%). No child with an unremarkable history and exam was found to have electrolyte abnormalities falling below levels most likely to be associated with acute symptomatic seizures. Electrolytes are unlikely to be abnormal in an otherwise well-appearing child after a first-time nonfebrile seizure.
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Hyperosmolar hyperglycemic state secondary to neuroleptic malignant syndrome. Am J Emerg Med 2015; 33:126.e1-2. [DOI: 10.1016/j.ajem.2014.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 06/03/2014] [Accepted: 06/03/2014] [Indexed: 11/19/2022] Open
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Sakai T, Tomimoto H. [Central pontine myelinolysis developed during alcohol withdrawal in a chronic alcoholic with hyperosmolar hyperglycemic state]. Rinsho Shinkeigaku 2014; 54:116-123. [PMID: 24583585 DOI: 10.5692/clinicalneurol.54.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We present a 46-year-old man with central pontine myelinolysis (CPM). He had been diagnosed with diabetes mellitus and chronic pancreatitis. He had drunk more than 1.2 l of Japanese sake daily for 20 years and more. He developed slight reduction of consciousness, dysarthria and truncal ataxia 7 days after he stopped drinking. The laboratory data on admission showed hyperosmolar hyperglycemic state, according to the following findings; glucose 1,058 mg/dl, serum osmolality 328 mOsm/l and serum sodium 119 mEq/l. According as administration of acetic Ringer's solution and insulin injection, the laboratory data 14 hours after admission showed glucose 235 mg/dl, serum osmolality 290 mOsm/l and serum sodium 131 mEq/l. The initial diffusion weighted images (DWI) on MRI revealed a small high signal intensity spot in the pons. The second DWI after 14 days revealed a trident-shaped hyperintensity in the pons that was compatible with CPM. His symptoms showed no remarkable changes, but susceptibility weighted images of MRI after 4 months revealed low signal intensity area in the CPM lesion that indicated pontine hemorrhage. We speculate that marked fluctuation of serum osmotic pressure associated with the rapid change of the serum glucose had a significant role in the pathogenesis of the present case. Therefore, we recommend gradual correction of serum glucose and serum osmolality to maintain less than 12 mEq/l/day as correction of chronic hyponatremia in to prevent and ameliorate pathologic condition of CPM.
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Affiliation(s)
- Toshiyuki Sakai
- Department of Neurology, Saiseikai Matsusaka General Hospital
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Abstract
Diabetic ketoacidosis (DKA) and the hyperglycemic hyperosmolar state (HHS) are potentially fatal hyperglycemic crises that occur as acute complications of uncontrolled diabetes mellitus. The authors provide a review of the current epidemiology, precipitating factors, pathogenesis, clinical presentation, evaluation, and treatment of DKA and HHS. The discovery of insulin in 1921 changed the life expectancy of patients with diabetes mellitus dramatically. Today, almost a century later, DKA and HHS remain significant causes of morbidity and mortality across different countries, ages, races, and socioeconomic groups and a significant economic burden for society.
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Affiliation(s)
- Jelena Maletkovic
- Department of Endocrinology, UCLA School of Medicine, Gonda Diabetes Center, 200 UCLA Medical Plaza, Suite 530, Los Angeles, CA 90095, USA.
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Trotman TK, Drobatz KJ, Hess RS. Retrospective evaluation of hyperosmolar hyperglycemia in 66 dogs (1993-2008). J Vet Emerg Crit Care (San Antonio) 2013; 23:557-64. [PMID: 24102960 DOI: 10.1111/vec.12100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 08/04/2013] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To clinically characterize a large group of dogs with the hyperosmolar hyperglycemic state (HHS) and to determine whether 2 HHS subgroups, dogs with hyperosmolar ketonuric (HK) diabetes mellitus (DM) and dogs with hyperosmolar nonketonuric (HNK) DM were clinically different from one another. DESIGN Retrospective study. Records of 1,250 diabetic dogs that were examined between January 1993 and July 2008 were reviewed in order to identify dogs with HHS. Inclusion required a calculated serum osmolality ≥325 mOsm/kg, with or without ketonuria. SETTING University teaching hospital. ANIMALS Sixty-six dogs with HHS including 34 dogs with HK, 25 dogs with HNK, and 7 dogs with unclassified HHS. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS HHS was diagnosed in 5% of dogs with DM. HK and HNK dogs were similar to one another in regard to most historical, physical examination, and clinicopathologic variables as well as outcome. Sixty-two percent of dogs with HHS survived to discharge from the hospital. Poor outcome of HHS dogs was associated with abnormal mental status (P = 0.03) and a low venous pH (P = 0.045). Dogs with HK were significantly more likely to have acute pancreatitis (P = 0.046), higher body temperature (P = 0.006), higher WBC count (P = 0.01), and a shorter duration of clinical signs (P = 0.02) compared to dogs with HNK. Dogs with HNK had significantly higher BUN and creatinine concentrations (P = 0.0002 and P = 0.008, respectively) and higher calculated osmolality (P = 0.001) compared to dogs with HK. CONCLUSIONS HHS is a rare condition in which poor outcome is associated with abnormal mental status and low venous pH. Among dogs with HHS, the subgroup of dogs with HK has significantly more acute pancreatitis, shorter duration of clinical signs, and higher body temperature and WBC count compared to dogs with HNK, whereas dogs with HNK have more azotemia and higher calculated osmolality compared to dogs with HK.
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Affiliation(s)
- Tara K Trotman
- Department of Clinical Sciences, School of Veterinary Medicine, Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania, Philadelphia, PA, 19104
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Vuong AM, Huber JC, Bolin JN, Ory MG, Moudouni DM, Helduser J, Begaye D, Bonner TJ, Forjuoh SN. Factors affecting acceptability and usability of technological approaches to diabetes self-management: a case study. Diabetes Technol Ther 2012; 14:1178-82. [PMID: 23013155 PMCID: PMC3521137 DOI: 10.1089/dia.2012.0139] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE This study explored the impact of personal digital assistant (PDA) features, users' perceptions, and other factors that may have hindered PDA acceptability and usability as technology advances in e-health diabetes self-management. STUDY DESIGN AND RESULTS An ongoing study on PDA usage is set within the context of the advancements of Web 2.0 for type 2 diabetes mellitus (T2DM) self-management e-interventions. Advancements in technology as it relates to the future of T2DM mobile applications are discussed as possible deterrents of PDA acceptability and usability. CONCLUSIONS This case study illustrates the importance of addressing factors that may impede the adoption of electronic devices intended for sustained health behavior change. Recognizing the importance of individual perception within the context of rapid technological advancements is imperative for designing future health interventions. Incorporating electronic devices that individuals are more inclined to utilize, such as smartphones, as the platform for health interventions is a promising strategy to improve acceptability and usability, allowing researchers to more accurately assess the health benefits of self-management programs.
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Affiliation(s)
- Ann M. Vuong
- Department of Epidemiology & Biostatistics, Texas A&M Health Science Center, College Station, Texas
| | - John C. Huber
- Department of Epidemiology & Biostatistics, Texas A&M Health Science Center, College Station, Texas
| | - Jane N. Bolin
- Department of Health Policy & Management, Texas A&M Health Science Center, College Station, Texas
| | - Marcia G. Ory
- Department of Health Promotion & Community Health Sciences, School of Rural Public Health; Texas A&M Health Science Center, College Station, Texas
| | - Darcy M. Moudouni
- Department of Health Policy & Management, Texas A&M Health Science Center, College Station, Texas
| | - Janet Helduser
- Department of Health Policy & Management, Texas A&M Health Science Center, College Station, Texas
| | - Dawn Begaye
- Department of Family & Community Medicine, Scott and White Healthcare, Temple, Texas
| | - Timethia J. Bonner
- Department of Health and Kinesiology, Texas A&M University, College Station, Texas
| | - Samuel N. Forjuoh
- Department of Epidemiology & Biostatistics, Texas A&M Health Science Center, College Station, Texas
- Department of Health Promotion & Community Health Sciences, School of Rural Public Health; Texas A&M Health Science Center, College Station, Texas
- Department of Family & Community Medicine, Scott and White Healthcare, Temple, Texas
- College of Medicine, Texas A&M Health Science Center, College Station, Texas
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Chianura L, Errante IC, Travi G, Rossotti R, Puoti M. Hyperglycemia in severe falciparum malaria: a case report. Case Rep Crit Care 2012; 2012:312458. [PMID: 25161774 PMCID: PMC4010067 DOI: 10.1155/2012/312458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 10/13/2012] [Indexed: 12/04/2022] Open
Abstract
Occasionally, malaria may present with unusual signs and symptoms. We report a case of an uncommon presentation of Plasmodium falciparum infection in a 59-year-old Ethiopian immigrant, which initially presented with hyperglycaemia and multiple organ dysfunction syndrome (MODS). Reports of unusual presentations of malaria are few and cases of severe malaria with hyperglycaemia are rarely described. As hyperglycaemia is associated to most severe malaria and high mortality, our aim is to catch the attention of the physicians on this entity.
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Affiliation(s)
- Leonardo Chianura
- Department of Infectious Diseases, Niguarda Cà Granda Hospital, Piazza Ospedale Maggiore 3, 20162 Milano, Italy
| | - Isabella Corinna Errante
- Department of Infectious Diseases, Niguarda Cà Granda Hospital, Piazza Ospedale Maggiore 3, 20162 Milano, Italy
| | - Giovanna Travi
- Department of Infectious Diseases, Niguarda Cà Granda Hospital, Piazza Ospedale Maggiore 3, 20162 Milano, Italy
| | - Roberto Rossotti
- Department of Infectious Diseases, Niguarda Cà Granda Hospital, Piazza Ospedale Maggiore 3, 20162 Milano, Italy
| | - Massimo Puoti
- Department of Infectious Diseases, Niguarda Cà Granda Hospital, Piazza Ospedale Maggiore 3, 20162 Milano, Italy
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Kuo FC, Hung YJ, Hsieh CH, Hsiao FC. An occult aldosterone-producing adenoma initially presenting as hyperosmolar hyperglycaemic state. Ann Clin Biochem 2012; 49:505-7. [PMID: 22914443 DOI: 10.1258/acb.2012.011237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Aldosterone-producing adenoma (APA), one of the most common causes of primary hyperaldosteronism, is clinically characterized by hypertension, increased sodium retention, increased potassium excretion and altered glucose metabolism. APA can also manifest in the form of hyperosmolar hyperglycaemic state (HHS), which is a life-threatening acute diabetic complication. Infection and inadequate fluid replacement are the common precipitating and predisposing factors for the occurrence of HHS. Here, we report a case of occult APA with the initial presentation of HHS, in which an unusually rapid correction of diabetes was observed after correct diagnosis and surgical resection of the APA. To our knowledge, this is the first case with such manifestations and outcome.
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Affiliation(s)
- Feng-Chih Kuo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Chenggong Road, Neihu District, Taipei City 114, Taiwan
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Tsai SL, Hadjiyannakis S, Nakhla M. Hyperglycemic hyperosmolar syndrome at the onset of type 2 diabetes mellitus in an adolescent male. Paediatr Child Health 2012; 17:24-6. [DOI: 10.1093/pch/17.1.24] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2011] [Indexed: 11/13/2022] Open
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Dean H, Sellers E, Kesselman M. Acute hyperglycemic emergencies in children with type 2 diabetes. Paediatr Child Health 2011; 12:43-4. [PMID: 19030340 DOI: 10.1093/pch/12.1.43] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2006] [Indexed: 11/13/2022] Open
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Hyperglycemic hyperosmolar syndrome in children: pathophysiological considerations and suggested guidelines for treatment. J Pediatr 2011; 158:9-14, 14.e1-2. [PMID: 21035820 DOI: 10.1016/j.jpeds.2010.09.048] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Revised: 07/23/2010] [Accepted: 09/20/2010] [Indexed: 12/31/2022]
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Abd Hamid H, Umar NA, Othman H, Das S. A case of hyperosmolar hyperglycaemic state with involuntary movements - diagnostic dilemma and clinical considerations. Arch Med Sci 2010; 6:987-90. [PMID: 22427779 PMCID: PMC3302717 DOI: 10.5114/aoms.2010.19315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2009] [Revised: 09/01/2009] [Accepted: 09/14/2009] [Indexed: 11/17/2022] Open
Abstract
Hyperosmolar hyperglycaemic state (HHS) is a medical emergency which needs immediate medical intervention. A 37-year-old Chinese woman with a history of hypertension attended the Emergency Department. She had a two-day history of involuntary movement, i.e. chorea of the upper limbs, preceded by a one-week history of upper respiratory tract infection. She also had polyuria and polydipsia, although she was never diagnosed as diabetic. The main aim of reporting the present case was to highlight the importance of biochemical investigations involved in the diagnosis of involuntary movements.
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Affiliation(s)
- Hanisah Abd Hamid
- Department of Pathology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Nor-Aini Umar
- Department of Pathology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Hanita Othman
- Department of Pathology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Srijit Das
- Department of Anatomy, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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Lin PY, Wang CY, Wang JY. Hyperosmolar hyperglycemic state induced myocardial infarction: a complex conjunction of chronic and acute complications with diabetes mellitus. J Cardiovasc Med (Hagerstown) 2010; 11:127-9. [DOI: 10.2459/jcm.0b013e32832fd4a0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Rosenbloom AL. Hyperglycemic hyperosmolar state: an emerging pediatric problem. J Pediatr 2010; 156:180-4. [PMID: 20105637 DOI: 10.1016/j.jpeds.2009.11.057] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Revised: 10/12/2009] [Accepted: 11/19/2009] [Indexed: 01/14/2023]
Affiliation(s)
- Arlan L Rosenbloom
- Division of Endocrinology, Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL, USA.
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Beavers C, Harrison M, Gehrs B, Blick K. Lethargy and Seizures in a 52-Year-Old Male. Lab Med 2009. [DOI: 10.1309/lm9su3ktv2bjifnj] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Megarbane B, Marsanne C, Meas T, Médeau V, Guillausseau PJ, Baud FJ. Acute lower limb ischemia is a frequent complication of severe diabetic hyperosmolarity. DIABETES & METABOLISM 2007; 33:148-52. [PMID: 17320451 DOI: 10.1016/j.diabet.2006.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2006] [Accepted: 11/12/2006] [Indexed: 10/23/2022]
Abstract
AIM To describe the outcome of intensive care unit (ICU) patients admitted with a hyperglycaemic hyperosmolar non-ketotic syndrome (HHNS), with a specific analysis of precipitating conditions and complications including lower limb ischemia. METHODS Retrospective review of patients admitted in a university-hospital ICU for HHNS. RESULTS Seventeen consecutive patients (9F/8M, age: 75 years [57-81] (median [25-75% percentiles], Glasgow Coma score: 13 [12-14]) were admitted for HHNS over an 8-year period (1998-2005). On admission, the blood glucose level was 40.0 mmol/l [26.3-60.8], the corrected serum sodium concentration 167 mmol/l [158-174], and the calculated plasma osmolarity 384 mosmol/l [365-405]. All the patients presented with renal failure due to severe dehydration. An infection was identified as the precipitating factor in 8/17 cases. Three (18%) patients died in the ICU. Non-survivors were significantly older than survivors (P=0.02). Using univariate analysis, no other parameter measured on admission was related to mortality. Four patients (24%) presented with lower limb ischemia. They had a significantly more elevated blood urea nitrogen (P=0.03), creatinine phosphokinase level (P=0.04), and leukocyte count (P=0.02). The bilateral, symmetrical, and distal extremity involvement suggested diminished blood flow due to hyperviscosity, hypotension, vasoconstrictors, or cholesterol emboli rather than a proximal arterial obstruction as causative mechanisms. No patient was treated surgically. Ischemia reversed with fluid loading and resulted in toe dry digital necrosis. CONCLUSION HHNS is a rare but life-threatening cause of ICU admission. There is a high incidence of lower limb ischemia in HHNS patients, which may be related to dehydration and blood hyperviscosity.
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Affiliation(s)
- B Megarbane
- Service de réanimation médicale et toxicologique, APHP, hôpital Lariboisière, université Paris-VII, 2 rue Ambroise-Paré, 75010 Paris, France.
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Affiliation(s)
- Chayim Y Newmark
- Saint Barnabas Medical Center/Ambulatory Care Center, Livingston, New Jersey 07039, USA.
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Abstract
Enhanced life expectancy and the aging of society have conspired with rising rates of obesity and physical inactivity to cause an unprecedented increase in diabetes prevalence worldwide. The disease and its chronic complications have unique presentations and challenges in the elderly. Postprandial hyperglycemia may be the predominant manifestation, comorbid health conditions are often present, and the risk of cardiovascular disease is vastly increased. Periodic screening is essential for early diagnosis and proper treatment. The principles of multidisciplinary management emphasizing nutrition, exercise, education, psychosocial care, attention to concomitant metabolic risk factors, and prudent use of pharmacologic agents are the mainstay of therapy for older adults. Treatment should be tailored to the individual patient, and the assistance of family and caregivers should be combined with rational utilization of community resources. An evidence-based, comprehensive, and proactive approach is needed to reduce the burden of morbidity and mortality from diabetes in the elderly.
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Affiliation(s)
- Ali A Rizvi
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, University of South Carolina School of Medicine, Columbia, South Carolina, USA.
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