1/10. 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 = ketoacidosis (Clic here for more details about this article) |
2/10. Clonic focal seizure of the foot secondary to nonketotic hyperglycemia.Focal epileptic seizures can be the first manifestation of a diabetic disorder. Metabolic disturbances, including hyperglycemia, mild hyperosmolality, hyponatremia, and lack of ketoacidosis contribute to the development of partial focal seizures. A review of the medical literature for partial focal seizures is presented, followed by a case study of a patient who developed clonic seizures of the right foot secondary to hyperglycemia, hyponatremia, and hyperosmolality.- - - - - - - - - - ranking = 1keywords = ketoacidosis (Clic here for more details about this article) |
3/10. 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 = 2.5056290558736keywords = ketosis (Clic here for more details about this article) |
4/10. death caused by hyperglycemic hyperosmolar state at the onset of type 2 diabetes.Seven obese African American youth were considered to have died from diabetic ketoacidosis (DKA) due to type 1 diabetes, despite meeting the criteria for hyperglycemic hyperosmolar state and not for DKA. All had previously unrecognized type 2 diabetes, and death may have been prevented with earlier diagnosis or treatment.- - - - - - - - - - ranking = 1keywords = ketoacidosis (Clic here for more details about this article) |
5/10. Childhood diabetes presenting with hyperosmolar dehydration but without ketoacidosis: a report of three cases.BACKGROUND: diabetic ketoacidosis (DKA) is a common mode of presentation of diabetes mellitus in children, accounting for 26% of new cases. Rarely, children with diabetes may develop other forms of metabolic decompensation associated with hyperglycaemia and hyperosmolality. Hyperglycaemia and hyperosmolality without ketoacidosis has high mortality in adults, although there is no data on mortality in children. case reports: We describe three children who presented to Birmingham Children's Hospital and were initially suspected to have DKA. Each child was severely hyperglycaemic and hyperosmolar but without significant ketosis or acidosis. In two of the three children, the hyperosmolar state was associated with the ingestion of large volumes of high calorie fluids preceding the presentation. These children were exquisitely sensitive to insulin and may be at a significantly higher risk of cerebral oedema in view of their hyperosmolar state. CONCLUSIONS: Hyperosmolar hyperglycaemia is a serious and rare complication at presentation of diabetes in children, and should be distinguished from DKA. These children are at an increased risk of cerebral oedema compared with DKA, and one should have a low threshold for suspicion of this complication.- - - - - - - - - - ranking = 8.5056290558736keywords = ketosis, ketoacidosis (Clic here for more details about this article) |
6/10. Nonketotic hyperosmolar coma in a patient with type 1 diabetes-related diabetic nephropathy: case report.Nonketotic hyperosmolar coma (NHC) is characterized by severe hyperglycemia; absence of, or only slight ketosis; nonketotic acidosis; severe dehydration; depressed sensorium or frank coma; and various neurologic signs. This condition is uncommon in type 1 diabetes. Because of little or no osmotic diuresis in patients with diabetic nephropathy, increases in plasma osmolality and therefore the likelihood of neurologic symptoms are limited. A 20-year-old male patient with type 1 diabetes with chronic kidney disease on conservative treatment (glomerular filtration rate [GFR], 18 mL/dk) presented with acute nonketotic hyperosmolar syndrome. The patient was admitted presenting with thirst, fatigue, and drowsiness. Blood biochemistry levels were urea 87 mg/dL, creatinine 5.09 mg/dL, glucose 830 mg/dL, glycosylated hemoglobin (HbA1c) 8%, C peptide <0.3 ng/mL, sodium 131 mmol/L, chloride 93 mmol/L, potassium 5.2 mmol/L, and calculated serum osmolality 385 mOsm/kg. The presumptive diagnosis on admission was nonketotic hyperosmolar syndrome precipitated by urinary infection. This is the first case report of hyperosmolar coma in a patient with type 1 diabetes with chronic kidney disease.- - - - - - - - - - ranking = 2.5056290558736keywords = ketosis (Clic here for more details about this article) |
7/10. A case of diabetic non-ketotic hyperosmolar coma with an increase with plasma 3-hydroxybutyrate.We have seen a case of "diabetic non-ketotic hyperosmolar coma" with ketosis. An 84-year-old man was brought into the hospital in a deeply comatous and dehydrated state. The initial blood glucose level was 1252 mg/dl with plasma osmolarity of 435 mOsm/l, but no ketonuria was detected by the nitroprusside method (Ketostix). However, the plasma 3-hydroxybutyrate (3-OHBA) level was 5 mM in a newly developed bedside film test. The serum ketone bodies were later found to be 5.56 and 0.82 mmol/l for 3-OHBA and acetoacetate (AcAc), respectively. A marked increase in glucagon, cortisol and ADH with renal dysfunction (creatinine 5.0 mg/dl) were noted. An abnormal electrocardiogram, occular convergence and chorea like movement disappeared after correction of metabolic disturbances. The moderate level of IRI (14 microU/ml) on admission and a good response to glucagon 2 months after admission also indicate that the present case is a typical hyperosmolar non-ketotic coma. Because of a preferential increase in 3-OHBA, ketonuria seemed to be absent in the regular nitroprusside test. Marked dehydration is thought to cause renal dysfunction, and the increase in ADH may have helped to prevent further aggravation of ketoacidosis. We propose to change the term hyperosmolar non-ketotic coma (HNC) to diabetic hyperosmolar coma (DHC), because sometimes patients with hyperosmolar non-ketotic diabetic coma are ketotic, as seen in the present case. Determination of 3-OHBA or individual ketone bodies in blood is important and essential for the differential diagnosis of diabetic coma. The diagnosis of either ketoacidotic or hyperosmolar coma should be made depending on the major expression of ketoacidosis or hyperglycemic hyperosmolarity.- - - - - - - - - - ranking = 4.5056290558736keywords = ketosis, ketoacidosis (Clic here for more details about this article) |
8/10. Cerebral edema complicating nonketotic hyperosmolar coma.Cerebral edema as a complication of the therapy of diabetic coma has been described for over 50 years, although modern awareness dates to about 1967. Almost all cases have occurred in patients with diabetic ketoacidosis (DKA). Although a few cases of cerebral edema have been reported in patients with nonketotic hyperosmolar coma (NKHC), these are in general not well documented by either autopsy data of cat scans. Over a period of 9 years, I have encountered 5 patients who developed cerebral edema as a complication of the therapy of NKHC. The initial plasma glucose in these patients was 1,496 /- (SD) 296 mg/dl and plasma osmolality was 382 /- 29 mosm/kg. All had depression of sensorium to at least a stupor (stage I coma or greater). All were treated with intravenous insulin and either 77 or 154 mM NaCl, and plasma glucose fell at a mean rate of 38 mg/dl/h. In all patients, plasma glucose fell below 250 mg/dl (mean of 18 /- 66 mg/dl) and all patients experienced increased depression of sensorium, elevated csf pressure, and brain swelling as diagnosed by cat scanning. Therapy with various combinations of glucose, mannitol and steroids were without effect. In 1 patient, insertion of a subdural intracranial screw lowered intracranial pressure from 24 to 3 cm of H2O. Three of the 5 patients died and 2 remain in a persistent vegetative state, 1 of whom is also quadriplegic.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 1keywords = ketoacidosis (Clic here for more details about this article) |
9/10. Hyperglycemic hyperosmolar coma in a 9-month-old child.Hyperglycemic hyperosmolar coma is a life-threatening emergency with a mortality much higher than that of other forms of hyperosmolarity such as hypernatremia or diabetic ketoacidosis. Despite the differences in the three conditions, present evidence suggests that correction of hyperosmolarity should proceed slowly to avoid the seizures that may occur in all three conditions. This report describes a 9-month-old diabetic child who initially had hyperglycemic hyperosmolar coma and who is one of the youngest survivors of this syndrome in the American literature. This case report points out the limited understanding of the pathophysiology of this syndrome and the consequent problems of therapy.- - - - - - - - - - ranking = 1keywords = ketoacidosis (Clic here for more details about this article) |
10/10. Nonketotic hyperosmolar coma in two diabetic children.Two diabetic children with nonketotic hyperosmolar coma were treated successfully. In one of the patients, plasma-free fatty acids, insulin, c-peptide and two lipolytic hormones (growth hormone and cortisol) were measured serially during the coma. Free fatty acids, insulin, c-peptide, growth hormone and cortisol levels were within normal ranges and subsequently these levels did not change significantly. The results suggest that the normal levels of lipolytic hormones may account for the normal plasma free fatty acids and the absence of ketosis found in children with nonketotic hyperosmolar coma, in contrast to the elevated levels of lipolytic hormones and ketone bodies in ketoacidotic diabetic coma.- - - - - - - - - - ranking = 2.5056290558736keywords = ketosis (Clic here for more details about this article) |
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