1/31. Bilateral basal ganglion haemorrhage in diabetic ketoacidotic coma: case report.We report bilateral oedema and haemorrhagic transformation in the basal ganglia of a 59-year old woman with severe diabetic ketoacidosis. Lack of cerebral vascular autoregulation, followed by blood-brain barrier disruption due to the so-called breakthrough mechanism is presumed to be the cause.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
2/31. Diabetes in pregnancy: the midwifery role in management.Although the primary focus of midwifery is on uncomplicated pregnancy, all midwives must screen for and, in some cases, comanage the care of women with diabetes mellitus and gestational diabetes. This article will review the types of diabetes, implications for preconceptional and pregnancy care, the changing recommendations relative to diabetes in pregnancy, and the role of the midwife in providing antepartal and intrapartal care for women with diabetes in collaboration with other health care professionals and in accordance with the philosophy and standards of the American College of Nurse-Midwives. A specific case study will highlight the role of the midwife, with an overall focus on medical consultation, collaboration, and referral, as well as client involvement in the planning of care.- - - - - - - - - - ranking = 0.25keywords = coma (Clic here for more details about this article) |
3/31. Hyperosmolar diabetic non-ketotic coma, hyperkalaemia and an unusual near death experience.Generally, cardiac arrest due to pulseless electrical activity has a poor outcome, except when reversible factors such as acute hyperkalaemia are identified and managed early. Hyperosmolar diabetic non-ketotic coma may lead to acute hyperkalaemia. Hyperosmolar diabetic non-ketotic coma is a metabolic emergency usually seen in elderly non-insulin dependent diabetics, characterized by severe hyperglycaemia, volume depletion, altered consciousness, confusion and less frequently neurological deficit. Cerebrovascular accident or transient ischaemic attack may be mistakenly diagnosed, particularly if the patient has no history of diabetes mellitus. Delays in diagnosis and management of glycaemic emergencies presenting as a constellation of neurological abnormalities can be avoided by routine early measurement of blood glucose. Hyperosmolar diabetic non-ketotic coma should be considered in any patient with altered consciousness or neurologic deficit in conjunction with hyperglycaemia. As hyperosmolar diabetic non-ketotic coma results in severe fluid depletion, electrolyte disturbance, profound hyperglycaemia and an altered mental state, the guiding principles of therapy include aggressive rehydration, insulin therapy, correction of electrolyte abnormalities and treatment of any underlying illnesses. Treatment of acute hyperkalaemia includes calcium ions, insulin with dextrose, salbutamol and haemodialysis.- - - - - - - - - - ranking = 2keywords = coma (Clic here for more details about this article) |
4/31. uterine artery aneurysm mimicking pelvic sarcoma. A case report and review of literature. [email protected].We report a case of true uterine artery aneurysm in a 77-year-old diabetic woman, which was suspected radiologically as a pelvic sarcoma. The aneurysm was communicating with the atherosclerotic left uterine artery. Pelvic aneurysms carry the potential risk of massive intra-operative hemorrhage if the diagnosis was not established prior to operation.- - - - - - - - - - ranking = 1.25keywords = coma (Clic here for more details about this article) |
5/31. Dislocation of the lens: a complication after cyclocryotherapy.An unusual complication is reported of a case of complete dislocation of the lens after cyclocryotherapy in a patient with neovascular glaucoma. To the best of the authors' knowledge, no case of lens dislocation following cyclocryotherapy has previously been reported.- - - - - - - - - - ranking = 0.25keywords = coma (Clic here for more details about this article) |
6/31. hypoglycemia due to nateglinide administration in diabetic patient with chronic renal failure.A 56-year-old woman with diabetic triopathy, rheumatoid arthritis and chronic renal failure was admitted for severe hypoglycemic coma. arthralgia had been deteriorating for 6 months. Therefore, 5 mg of prednisolone was administered. Postprandial blood glucose (PPG), however, elevated from 260 to 290 mg/dl, although fasting blood glucose (FBG) levels ranged from 80 to 110 mg/dl. Three months after, 270 mg of nateglinide was given in addition to acarbose. After 2 days, hypoglycemia occurred at 02:00 h. Nateglinide was then decreased to 180 mg (before breakfast and lunch). After 5 days, hypoglycemia re-occurred at 01:00 h. Nateglinide was subsequently decreased to 90 mg before breakfast. The PPG levels ranged from 130 to 150 mg/dl. hypoglycemia did not occur during the next 2 months. On admission, FBG; 59 mg/dl, fasting immunoreactive insulin; 34 microU/ml, indicated hyperinsulinemic hypoglycemia. We administered 20 g of glucose intravenously, however, hypoglycemia recurred 4 times and 20 g of glucose was then administered. Although the plasma nateglinide level decreased, the nateglinide metabolite, N-[trans-4-(1-hydroxy-1methylethyl)-cyclohexanecarbonyl]-D-phenylalanine levels still had not decreased 29 h after nateglinide administration. Therefore, chronic renal failure appeared to alter the pharmacokinetic parameters of the nateglinide metabolite, which had accumulated by chronic renal failure. The nateglinide metabolite caused severe hypoglycemia in this case.- - - - - - - - - - ranking = 0.25keywords = coma (Clic here for more details about this article) |
7/31. Fatal malignant hyperthermia-like syndrome with rhabdomyolysis complicating the presentation of diabetes mellitus in adolescent males.OBJECTIVE: This report describes a new fatal syndrome observed in adolescent males at the initial presentation of diabetes mellitus. The features include hyperglycemic hyperosmolar coma complicated by a malignant hyperthermia-like picture with fever, rhabdomyolysis, and severe cardiovascular instability. DESIGN: Case series. SETTING: Pediatric intensive care units of 3 tertiary care facilities in the united states. patients: Six adolescent males, 5/6 obese with acanthosis nigricans, 4/6 black. RESULTS: Four of 6 patients died. Four of 6 patients did not have significant ketosis. Six of 6 patients had increased temperature after the administration of insulin. CONCLUSIONS: The underlying etiology of this syndrome remains unclear. Possibilities include an underlying metabolic disorder such as a fatty acid oxidation defect, an unrecognized infection, exposure to an unknown toxin, or a genetic predisposition to malignant hyperthermia. Evaluation for all these possibilities and empiric treatment with dantrolene should be considered for this type of patient until this syndrome is better characterized.- - - - - - - - - - ranking = 0.25keywords = coma (Clic here for more details about this article) |
8/31. Klinefelter's syndrome accompanied by diabetes mellitus and diabetes insipidus.The first case of Klinefelter's syndrome accompanied by diabetes insipidus and diabetes mellitus is reported. A 41-year-old man admitted for hyperosmolar diabetic coma with a past history of diabetes insipidus was diagnosed as having Klinefelter's syndrome by endocrinological examination and sex chromosome analysis. In this case, glucose tolerance test was normalized half a year later and blood glucose was well controlled with diet therapy alone.- - - - - - - - - - ranking = 0.25keywords = coma (Clic here for more details about this article) |
9/31. Using an internet comanagement module to improve the quality of chronic disease care.BACKGROUND: Web-based applications have the potential to support the ongoing care needs of patients with chronic disease. At the University of washington, a diabetes care module was developed, and the feasibility of allowing patients with type 2 diabetes to comanage their disease from home was pilot tested. methods: The disease management module consisted of five Web sites that enabled patients to access their electronic medical records; upload blood glucose readings; enter medication, nutrition, and exercise data into an online diary; communicate with providers by using clinical e-mail; and browse an education site with endorsed content. All data could be viewed by patients and providers in online trended displays that a nurse practitioner case manager used to review cases weekly. RESULTS: "Proof-of-concept" was demonstrated by the three pilot participants who were the module's most active users. For example, one newly diagnosed patient was started on an oral hypoglycemic, underwent two upward dose adjustments, and achieved control (glycohemoglobin [HbA1c] from 8.0% to 6.1%). His treatment was conducted by exchanging 14 e-mails based on the 231 glucose-meter readings sent from home without requiring in-person follow-up visits. CONCLUSIONS: The internet offers the opportunity to involve patients and providers in collaborative management of chronic diseases between office visits.- - - - - - - - - - ranking = 1.25keywords = coma (Clic here for more details about this article) |
10/31. A 71-year-old man with hyperglycemia and mental status changes.Hyperglycemic hyperosmolar syndrome is an extreme but relatively common presentation of uncontrolled or new-onset diabetes mellitus. The diagnosis of the disorder itself is fairly straightforward, but the search for an underlying cause can be challenging. Infections are the usual precipitating factor, but a variety of other stressors can be involved. We report herein a patient presenting with hyperglycemic hyperosmolar coma with three possible precipitating infections: pharyngitis, urinary tract infection, and infective endocarditis.- - - - - - - - - - ranking = 0.25keywords = coma (Clic here for more details about this article) |
| | Next -> |