1/37. Riding out a diabetic emergency.Acute complications of diabetes are like a runaway roller coaster. Diabetes or its treatment can rocket your patient's blood glucose level to dizzying heights or plunge it to life-threatening lows. hypoglycemia, the most common endocrine emergency, typically occurs in a known diabetic patient whose therapy with insulin or oral diabetes agents goes awry. At the opposite extreme, soaring blood glucose levels mark the acute conditions diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic nonketotic state (HHNS). These complications may send the patient to the emergency department (ED) before he even knows he has diabetes. In this article, I'll explain how these problems develop and spell out nursing measures to get your patient back on track.- - - - - - - - - - ranking = 1keywords = diabetes (Clic here for more details about this article) |
2/37. A case of hyperosmolar nonketotic coma occurring during chemotherapy using cisplatin for gallbladder cancer.A 61 year-old woman was admitted to our hospital because of an abdominal tumor. She was diagnosed with recurrent gallbladder cancer, and treated with cisplatin (CDDP). On day 6, after the 1st cycle of chemotherapy, she developed confusion and suddenly became comatose. She was diagnosed as having hyperosmolar nonketotic coma (HNC) on day 7. She had no history of diabetes mellitus. She recovered from HNC after 3 days of treatment with continuous infusion of 0.45% saline and moderate amounts of insulin. HNC may be a complication of CDDP chemotherapy in patients with malignancy. early diagnosis and appropriate treatment is necessary for HNC occurring during chemotherapy for malignant disease.- - - - - - - - - - ranking = 1.1563395675499keywords = diabetes mellitus, diabetes, mellitus (Clic here for more details about this article) |
3/37. Elevated serum creatine kinase activity in a patient with acute pancreatitis.A 62-year-old man presented with a five-day history of a 'flu-like' illness, epigastric pain and a state of increasing confusion. His serum values for amylase and glucose were grossly elevated, as was the creatine kinase (CK) activity, being 23 times above the upper limit of normal. CK-MB was less than 5% of his total CK activity. There was no past history of diabetes or recent history of intramuscular injections or injury. A diagnosis of acute pancreatitis complicated by hyperosmolar non-ketotic (HONK) diabetic pre-coma was made. The patient was treated with intravenous fluids, insulin and subcutaneous heparin. Normal values for serum amylase and CK activity were recorded with convalescence. This case indicates a possible association of a rise in total CK activity with acute pancreatitis complicated by HONK diabetic pre-coma. This observation was made in the absence of clinically evident muscle pathology.- - - - - - - - - - ranking = 0.33333333333333keywords = diabetes (Clic here for more details about this article) |
4/37. peritoneal dialysis in an infant with type 1 diabetes and hyperosmolar coma.Hyperosmolar coma which is characterized by severe hyperglycemia in absence of chetosis is very rare in pediatric age with only 11 cases reported in the literature. The outcome of the condition is usually poor with mental retardation being the most common event. Here a case of hyperosmolar coma is described in a female of three months of age who was treated with peritoneal dialysis 11 hours after admittance to hospital. This female patient has been receiving insulin from three months of age and today at the age of 10 years she leads a normal life despite being on insulin therapy. A very low level of c-peptide (<0.3 ng/ml) clearly confirms she is affected by Type 1 diabetes. To our knowledge this is the first case report of hyperosmolar coma in a neonate with Type 1 diabetes who survived this condition without late neurological consequences.- - - - - - - - - - ranking = 2keywords = diabetes (Clic here for more details about this article) |
5/37. 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 = 1.1563395675499keywords = diabetes mellitus, diabetes, mellitus (Clic here for more details about this article) |
6/37. Hyperosmolar syndrome in a patient with uncontrolled diabetes mellitus.Nonketotic hyperglycemic hyperosmolar syndrome (HHS) is found mostly in type 2 diabetic patients with marked hyperglycemia. HHS is a metabolic emergency and is associated with a high mortality rate. It is characterized by extreme dehydration and neurologic symptoms, which are related directly to the degree of hyperosmolality. We describe a 65-year-old patient who was admitted because of impaired consciousness caused by HHS. The relevant clinical and laboratory findings are discussed, and a brief overview of the pathophysiology and therapeutic management is provided.- - - - - - - - - - ranking = 4.6253582701997keywords = diabetes mellitus, diabetes, mellitus (Clic here for more details about this article) |
7/37. Cushing's syndrome manifesting as pseudo-central hypothyroidism and hyperosmolar diabetic coma.OBJECTIVE: To report an unusual case of Cushing's syndrome caused by an adrenal pheochromocytoma, manifesting as pseudo-central hypothyroidism and diabetic hyperosmolar coma. methods: A detailed case report is presented, including clinical, laboratory, and radiologic findings as well as results of selective adrenal vein sampling. RESULTS: In a 69-year-old woman with weight gain and hypothyroidism, diabetes mellitus with hyperosmolar coma developed precipitously. She had mild hypertension, but no diabetes was noted 2 weeks before the hyperosmolar event. Evaluation revealed Cushing's syndrome due to ectopic secretion of adrenocorticotropic hormone from an adrenal pheochromocytoma. After surgical resection of the tumor, the diabetes and the hypertension resolved. Furthermore, the pseudo-central hypothyroidism was eliminated, but primary hypothyroidism was unmasked. This combination has not been reported previously. CONCLUSION: This case illustrates the array of endocrinopathies that can be associated with pheochromocytoma, causing Cushing's syndrome.- - - - - - - - - - ranking = 1.8230062342166keywords = diabetes mellitus, diabetes, mellitus (Clic here for more details about this article) |
8/37. Bilateral putaminal hemorrhage with cerebral edema in hyperglycemic hyperosmolar syndrome.Bilateral putaminal hemorrhages rarely occur simultaneously in hypertensive patients. The association of intracerebral hemorrhage with cerebral edema (CE) has been rarely reported in diabetic patients. We present a patient with bilateral putaminal hemorrhage (BPH) and CE during the course of hyperglycemic hyperosmolar syndrome (HHS). A 40-year-old man with a history of diabetes mellitus and chronic alcoholism was admitted with acute impaired mentality. His blood pressure was within the normal range on admission. Laboratory results revealed hyperglycemia and severe metabolic acidosis without ketonuria. After aggressive treatment, plasma sugar fell to 217 mg/dl, but brain CT showed BPH and diffuse CE. Our case demonstrated that HHS should be considered as a cause of BPH with CE. Initial brain imaging study may be recommended for patients with diabetic coma.- - - - - - - - - - ranking = 1.1563395675499keywords = diabetes mellitus, diabetes, mellitus (Clic here for more details about this article) |
9/37. Hyperosmolar hyperglycaemic nonketotic coma associated with acute myocardial infarction: report of three cases.diabetes mellitus is one of the most commonly associated diseases of patients suffering an acute myocardial infarction. Although the coexistence of acute myocardial infarction with other clinical manifestations of diabetes have been well described, extremely few data exists about the concomitant occurrence of hyperosmolar hyperglycaemic nonketotic coma and myocardial infarctions.This article presents three patients with this association and aimed to discuss the clinical course and treatment strategies of this rare condition.- - - - - - - - - - ranking = 0.48338370325008keywords = diabetes, mellitus (Clic here for more details about this article) |
10/37. 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 = 5.7816978377496keywords = diabetes mellitus, diabetes, mellitus (Clic here for more details about this article) |
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