1.Trends in Hyperglycemic Crisis Hospitalizations and in- and out-of-Hospital Mortality in the Last Decade Based on Korean National Health Insurance Claims Data
Ji Hong YOU ; Sun Ok SONG ; Se Hee PARK ; Kyoung Hye PARK ; Joo Young NAM ; Dong Wook KIM ; Hyun Min KIM ; Dong Jun KIM ; Yong ho LEE ; Byung Wan LEE
Endocrinology and Metabolism 2019;34(3):275-281
BACKGROUND: Hyperglycemic crisis is a metabolic emergency associated with diabetes mellitus. However, accurate epidemiologic information on cases of hyperglycemic crisis in Korea remains scarce. We evaluated trends in hyperglycemic crisis hospitalizations and in- and out-of-hospital mortality in Korea. We also predicted future trends. METHODS: We extracted claims data with hyperglycemic crisis as the principal diagnosis from the National Health Insurance Service database in Korea from January 2004 to December 2013. We investigated the numbers of claims with hyperglycemic crisis and identified trends in hyperglycemic crisis based on those claims data. We predicted future trends by statistical estimation. RESULTS: The total annual number of claims of hyperglycemic crisis increased from 2,674 in 2004 to 5,540 in 2013. Statistical analysis revealed an increasing trend in hyperglycemic crisis hospitalizations (P for trend <0.01). In contrast, the hospitalization rate per 1,000 diabetes cases showed a decreasing trend (P for trend <0.01) during this period. The mortality rate per 1,000 diabetes cases also showed a decreasing trend (P for trend <0.0001). However, no distinct linear trend in the case-related fatality rate at <60 days over the last decade was observed. The predicted number of annual claims of hyperglycemic crisis will increase by 2030. CONCLUSION: The number of hyperglycemic crisis hospitalizations in Korea increased in the last decade, although the hospitalization rate per 1,000 diabetes cases and mortality rate decreased. Also, the predicted number of annual claims will increase in the future. Thus, it is necessary to establish long-term healthcare policies to prevent hyperglycemic crisis.
Delivery of Health Care
;
Diabetes Mellitus
;
Diabetic Ketoacidosis
;
Diagnosis
;
Emergencies
;
Epidemiology
;
Hospitalization
;
Hyperglycemic Hyperosmolar Nonketotic Coma
;
Korea
;
Mortality
;
National Health Programs
2.Short-term Effect of Ambient Air Pollution on Emergency Department Visits for Diabetic Coma in Seoul, Korea.
Hyunmee KIM ; Woojin KIM ; Jee Eun CHOI ; Changsoo KIM ; Jungwoo SOHN
Journal of Preventive Medicine and Public Health 2018;51(6):265-274
OBJECTIVES: A positive association between air pollution and both the incidence and prevalence of diabetes mellitus (DM) has been reported in some epidemiologic and animal studies, but little research has evaluated the relationship between air pollution and diabetic coma. Diabetic coma is an acute complication of DM caused by diabetic ketoacidosis or hyperosmolar hyperglycemic state, which is characterized by extreme hyperglycemia accompanied by coma. We conducted a time-series study with a generalized additive model using a distributed-lag non-linear model to assess the association between ambient air pollution (particulate matter less than 10 μm in aerodynamic diameter, nitrogen dioxide [NO2], sulfur dioxide, carbon monoxide, and ozone) and emergency department (ED) visits for DM with coma in Seoul, Korea from 2005 to 2009. METHODS: The ED data and medical records from the 3 years previous to each diabetic coma event were obtained from the Health Insurance Review and Assessment Service to examine the relationship with air pollutants. RESULTS: Overall, the adjusted relative risks (RRs) for an interquartile range (IQR) increment of NO2 was statistically significant at lag 1 (RR, 1.125; 95% confidence interval [CI], 1.039 to 1.219) in a single-lag model and both lag 0-1 (RR, 1.120; 95% CI, 1.028 to 1.219) and lag 0-3 (RR, 1.092; 95% CI, 1.005 to 1.186) in a cumulative-lag model. In a subgroup analysis, significant positive RRs were found for females for per-IQR increments of NO2 at cumulative lag 0-3 (RR, 1.149; 95% CI, 1.022 to 1.291). CONCLUSIONS: The results of our study suggest that ambient air pollution, specifically NO2, is associated with ED visits for diabetic coma.
Air Pollutants
;
Air Pollution*
;
Animals
;
Carbon Monoxide
;
Coma
;
Diabetes Mellitus
;
Diabetic Coma*
;
Diabetic Ketoacidosis
;
Emergencies*
;
Emergency Service, Hospital*
;
Female
;
Humans
;
Hyperglycemia
;
Hyperglycemic Hyperosmolar Nonketotic Coma
;
Incidence
;
Insurance, Health
;
Korea*
;
Medical Records
;
Nitrogen Dioxide
;
Nonlinear Dynamics
;
Prevalence
;
Seoul*
;
Sulfur Dioxide
3.Diabetic Ketoacidosis with Hyperglycemic Hyperosmolar State at the Onset of Type 2 Diabetes Mellitus in an Adolescent Male.
Jong Hyun KIM ; Eunjin CHOI ; Young Jun RHIE ; Jung Hwa LEE ; Kee Hyoung LEE ; Hyo Kyoung NAM
Soonchunhyang Medical Science 2016;22(2):158-162
A hyperglycemic hyperosmolar state is usually associated with type 2 diabetes. It has significant mortality and morbidity and is rare in the pediatric population. We describe a rare case of a 15-year-old boy with type 2 diabetes who presented to the emergency department with a mixed hyperglycemic hyperosmolar state and diabetic ketoacidosis. Excessive consumption of high-sugar carbonated drinks may have worsening the initial presentation. The patient recovered without any complications. We highlight the fact that gradual correction of osmolarity and sodium is important to avoid cerebral edema despite severe dehydration.
Adolescent*
;
Brain Edema
;
Carbonated Beverages
;
Dehydration
;
Diabetes Mellitus, Type 2*
;
Diabetic Ketoacidosis*
;
Emergency Service, Hospital
;
Humans
;
Hyperglycemic Hyperosmolar Nonketotic Coma
;
Male*
;
Mortality
;
Osmolar Concentration
;
Sodium
4.Prognostic Factors in Patients Hospitalized with Diabetic Ketoacidosis.
Avinash AGARWAL ; Ambuj YADAV ; Manish GUTCH ; Shuchi CONSUL ; Sukriti KUMAR ; Ved PRAKASH ; Anil Kumar GUPTA ; Annesh BHATTACHARJEE
Endocrinology and Metabolism 2016;31(3):424-432
BACKGROUND: Diabetic ketoacidosis (DKA) is characterized by a biochemical triad of hyperglycemia, acidosis, and ketonemia. This condition is life-threatening despite improvements in diabetic care. The purpose of this study was to evaluate the clinical and biochemical prognostic markers of DKA. We assessed correlations in prognostic markers with DKA-associated morbidity and mortality. METHODS: Two hundred and seventy patients that were hospitalized with DKA over a period of 2 years were evaluated clinically and by laboratory tests. Serial assays of serum electrolytes, glucose, and blood pH were performed, and clinical outcome was noted as either discharged to home or death. RESULTS: The analysis indicated that significant predictors included sex, history of type 1 diabetes mellitus or type 2 diabetes mellitus, systolic blood pressure, diastolic blood pressure, total leukocyte count, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, blood urea nitrogen, serum creatinine, serum magnesium, serum phosphate, serum osmolality, serum glutamic oxaloacetic transaminases, serum glutamic pyruvic transaminases, serum albumin, which were further regressed and subjected to multivariate logistic regression (MLR) analysis. The MLR analysis indicated that males were 7.93 times more likely to have favorable outcome compared with female patients (odds ratio, 7.93; 95% confidence interval, 3.99 to 13.51), while decreases in mean APACHE II score (14.83) and serum phosphate (4.38) at presentation may lead to 2.86- and 2.71-fold better outcomes, respectively, compared with higher levels (APACHE II score, 25.00; serum phosphate, 6.04). CONCLUSION: Sex, baseline biochemical parameters such as APACHE II score, and phosphate level were important predictors of the DKA-associated mortality.
Acidosis
;
APACHE
;
Blood Pressure
;
Blood Urea Nitrogen
;
Creatinine
;
Diabetes Mellitus, Type 1
;
Diabetes Mellitus, Type 2
;
Diabetic Ketoacidosis*
;
Electrolytes
;
Female
;
Glucose
;
Humans
;
Hydrogen-Ion Concentration
;
Hyperglycemia
;
Hyperglycemic Hyperosmolar Nonketotic Coma
;
Ketosis
;
Leukocyte Count
;
Logistic Models
;
Magnesium
;
Male
;
Mortality
;
Osmolar Concentration
;
Serum Albumin
;
Transaminases
5.A case of rhabdomyolysis developed in patient with thyroid storm.
Byung Ha CHUNG ; Song Wook CHUN ; Sung Ha HWANG ; Hyuk Sang KWON ; Kun Ho YOON ; Bong Yun CHA ; Ho Young SON
Korean Journal of Medicine 2004;66(6):635-638
Rhabdomyolysis is defined as skeletal muscle injury with release of muscle cell constituents into the plasma. Trauma and drugs are important causes of rhabdomyolysis and not rarely it is associated with metabolic disorders such as diabetic coma, severe electrolyte disturbances and myxedema coma. There are a few reports about rhabdomyolysis developed in patient with thyroid storm. which is defined as a sudden, life threatening exacerbation of thyrotoxicosis. In this report, we described the case of thyroid storm complicated by rhabdomyolysis.
Coma
;
Diabetic Coma
;
Humans
;
Muscle Cells
;
Muscle, Skeletal
;
Myxedema
;
Plasma
;
Rhabdomyolysis*
;
Thyroid Crisis*
;
Thyroid Gland*
;
Thyrotoxicosis
6.3 Cases of Acute Death dueto Pneumomediastinum, Pneumothorax and Subcutaneous Emphysema as a Complication of Miliary Tuberculosis.
Hyang Suk YUN ; Hyun Ju OH ; Hyung Suk BYUN ; Kyung Ryong HUH ; Chull SOHN
Journal of the Korean Pediatric Society 1981;24(9):891-896
Pneumomediastinum, pneumothorax and subcutaneous emphysema are uncommon in pediatric practice, but they may be rarely ocured in association with respiratory distress and excessive ressusciation in the neonatal period, and as a complication of bronchial asthma, measles in childhood. And also, there was a report of a few cases that developed to pneumomediastinum and subcutaneous emphysema caused by vomiting in patient of diabetic coma. It is rare so far in this country that above events are complicated by miliary tuberculosis, but they may lead the patient to fatal and lifethreatening conditions, even though we perform a considerable medical treatment for that. We presnted 3 cases of 6 month 20 days old female infant, and each 10 year and 11 year old boys, developed to pneumomediastinu, pneumothorax and subcutaneous emphysema, and suddenly expired during hospital treatment of miliary tuberculosis. And, we reviewed the literatures, too.
Asthma
;
Child
;
Diabetic Coma
;
Female
;
Humans
;
Infant
;
Measles
;
Mediastinal Emphysema*
;
Pneumothorax*
;
Subcutaneous Emphysema*
;
Tuberculosis, Miliary*
;
Vomiting
7.A Case of Panhypopituitarism with Rhabdomyolysis.
Sung Wook HONG ; Eun Jung LEE ; Ji Young PARK ; Ji Sung YOON ; Ji O MOK ; Yeo Joo KIM ; Hyeong Kyu PARK ; Jae Woo KIM ; Chul Hee KIM ; Sang Jin KIM ; Dong Won BYUN ; Kyo Il SUH ; Myung Hi YOO
Journal of Korean Society of Endocrinology 2005;20(2):174-178
Rhabdomyolysis is the consequence of extensive muscle injury with the release of muscle cell constituents into plasma. It can arise from trauma and also from a variety of nontraumatic causes. Trauma, drugs, toxins and infection are the major causes of rhabdomyolysis, but it is rarely associated with metabolic disorders such as severe electrolyte disturbance, diabetic ketoacidosis, hyperosmolar nonketotic coma, hypothyroidism and thyrotoxicosis. There have been several reported cases of metabolic rhabdomyolysis, but panhypopituitarism as a cause has never been identified. We experienced a case of acute rhabdomyolysis associated with panhypopituitarism. Thus, So we report this case with the review of related literature. Metabolic disorder is a rare cause of rhabdomyolysis, but it should always be considered in a patient having and unexplained increased of the creatine kinase concentration
Coma
;
Creatine Kinase
;
Diabetic Ketoacidosis
;
Humans
;
Hypothyroidism
;
Muscle Cells
;
Plasma
;
Rhabdomyolysis*
;
Thyrotoxicosis
8.Prevalence and Clinical Outcomes of Patients with Diabetic Ketoacidosis/Hyperglycemic Hyperosmolar Syndrome and COVID-19: A Systematic Review
Shane B. Villamonte ; Marilyn Katrina C. Caro ; Elaine C. Cunanan
Philippine Journal of Internal Medicine 2020;59(2):101-106
BACKGROUND AND OBJECTIVES. Several reports have shown that coexistence of diabetes mellitus and COVID-19 is one of the risk factors for poor outcome and increased mortality. Rapid metabolic deterioration with development of diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar syndrome (HHS) may result due to the acute insulin secretory capacity loss, stress condition and the cytokine storm. In this review, we aim to describe the prevalence of hyperglycemic crises(DKA/HHS) in patients with COVID-19 infection as well as their clinical outcomes.
METHODS. An intensive search was done using the WebMD, PubMed, Medline and Google Scholar databases for articles published between December 2019 to October 2020 that identified the number of patients who developed DKA and/or HHS among those who were admitted for COVID-19. Their clinical outcomes were likewise described.
RESULTS. This review included 4 articles in which individual quality was assessed. A total of 1282 patients were admitted for COVID-19 and the prevalence of DKA was 1.32%. HHS was not reported in any of the studies. Five (29.4%) of the patients with DKA and COVID-19 died and 12 (70.6%) recovered.
CONCLUSIONS. A significant number of COVID-19 patients developed DKA and it is associated with a high mortality rate. This reimposes the need for an appropriate algorithm for the optimal management of concomitant COVID 19 and hyperglycemic crises to avoid morbidity and mortality. Additionally, there is paucity of large-scale studies describing the prevalence of DKA/HHS in patients with COVID-19.
Diabetic Ketoacidosis
;
COVID-19
;
Water-Electrolyte Imbalance
;
Acid-Base Imbalance
;
Coma
9.A Case of Acquired Transient Laryngomalacia Associated with Diabetic Ketoacidosis.
Jun Sun RYU ; Dong Woo JEONG ; Yoon Keun PARK ; Ki Sik KIM
Korean Journal of Otolaryngology - Head and Neck Surgery 2001;44(5):543-545
Collapse of epiglottis during inspiration is an unusual cause of upper airway obstruction. It is usually classified as a congenital anomaly but several acquired cases have been reported to occur in patients who have lost pharyngeal airway support by head injury and coma. Recently, we experienced a case of laryngomalacia that was associated with diabetic ketoacidosis and compromised the airway. A tracheotomy was first needed to maintain the respiration, then conservative management including diabetes control was enough to restore the patient's condition. This case supports the neuromuscular dysfunction theory which purports laryngomalacia as its cause.
Airway Obstruction
;
Coma
;
Craniocerebral Trauma
;
Diabetic Ketoacidosis*
;
Epiglottis
;
Humans
;
Laryngomalacia*
;
Respiration
;
Tracheotomy
10.Endocrine and metabolic emergencies in children: hypocalcemia, hypoglycemia, adrenal insufficiency, and metabolic acidosis including diabetic ketoacidosis.
Annals of Pediatric Endocrinology & Metabolism 2015;20(4):179-186
It is important to fast diagnosis and management of the pediatric patients of the endocrine metabolic emergencies because the signs and symptoms of these disorders are nonspecific. Delayed diagnosis and treatment may lead to serious consequences of the pediatric patients, for example, cerebral dysfunction leading to coma or death of the patients with hypoglycemia, hypocalcemia, adrenal insufficiency, or diabetic ketoacidosis. The index of suspicion of the endocrine metabolic emergencies should be preceded prior to the starting nonspecific treatment. Importantly, proper diagnosis depends on the collection of blood and urine specimen before nonspecific therapy (intravenous hydration, electrolytes, glucose or calcium injection). At the same time, the taking of precise history and searching for pathognomonic physical findings should be performed. This review was described for fast diagnosis and proper management of hypoglycemic emergencies, hypocalcemia, adrenal insufficiency, and metabolic acidosis including diabetic ketoacidosis.
Acidosis*
;
Adrenal Insufficiency*
;
Calcium
;
Child*
;
Coma
;
Delayed Diagnosis
;
Diabetic Ketoacidosis*
;
Diagnosis
;
Electrolytes
;
Emergencies*
;
Glucose
;
Humans
;
Hypocalcemia*
;
Hypoglycemia*