In oder to evaluate the effect of hyperglycemic control and potential complications of the recommended protocol using small doses of inssulin in treating the non- ketotic hyperosmolar diabetics. 22 studies partients were used Regular insulin with an initial dose of 0.1 IU/kg/h by continuous intravenous infusion. The dose of insulin was reduced to 0.05 IU/kg/h when the patient’s glycemia dropped to a level of 16 mmol/l. Results: 17 non ketotic hyperosmolar coma patients (77%) were successfully treated and discharged. No severe complications concerned with the inssulin therapy (such as hypoglycemia; hypokalemia) were noticed in this study. 5 patients died. The mean total dose of insulin in these patients during the first 24 h was not significantly different from that of the other survivals. Conclusions: the proposed small doses of insulin by continuous intravenous infusion showed a high and safe effect in treatment of non- ketotic hyperosmolar diabetics.
Hyperglycemic Hyperosmolar Nonketotic Coma ; Insulin ; Diabetes Mellitus

Localized fibrous tumor of the pleura is rare, slowly growing, benign tumor. Most of these tumors clinically behave asymptomatically, although tumor-associated hypoglycemia occurs in a few cases and lead to hypoglycemic coma. Laboratory investigations show elevation of IGF-II with a 2-3 times higher effect on the blood glucose level than insulin. Surgical resection of the tumor is recommended. We report on the case of a 81-year-old man, who complained of hypoglycemic episodes. Diagnostic evaluation showed a fibrous tumor of pleura attached to the right diaphragm.
Aged, 80 and over ; Blood Glucose ; Coma ; Diaphragm ; Humans ; Hypoglycemia* ; Insulin ; Insulin-Like Growth Factor II ; Pleura*

We reported two cases of diabetic hyperglycemic hyperosmolar coma treated with maintaining continuous ambulatory peritoneal dialysis(CAPD) in chronic renal failure(CRF) patients with CAPD. Hyperglycemia is common complication in CAPD, but there were only few reports of severe hyperglycemia accompanying with hyperosmolar coma in CRF patients on CAPD therapy. Furthermore, to date, no specific management for CAPD patients with nonketotic hyperosmolar coma has been established. The best strategy for management of hyperosmolar coma with CAPD patients is changing CAPD therapy to HD. Recently, we experienced two cases of hyperglycemic hyperosmolar coma in diabetic CAPD patients successfully treated with intravenous hydration and insulin therapy without discontinuing CAPD therapy. Because no such case has been reported, we report two cases of diabetic hyperosmolar coma with CAPD treated without conversion to HD. These cases suggest that adequate fluid replacement accompanying electrolytes and osmotic balance as well as insulin therapy might be a major role for safe treatment of hyperglycemic hyperosmolar coma in patient with CAPD.
Coma* ; Electrolytes ; Humans ; Hyperglycemia ; Insulin ; Kidney Failure, Chronic* ; Peritoneal Dialysis, Continuous Ambulatory* ; Renal Dialysis

We reported two cases of diabetic hyperglycemic hyperosmolar coma treated with maintaining continuous ambulatory peritoneal dialysis(CAPD) in chronic renal failure(CRF) patients with CAPD. Hyperglycemia is common complication in CAPD, but there were only few reports of severe hyperglycemia accompanying with hyperosmolar coma in CRF patients on CAPD therapy. Furthermore, to date, no specific management for CAPD patients with nonketotic hyperosmolar coma has been established. The best strategy for management of hyperosmolar coma with CAPD patients is changing CAPD therapy to HD. Recently, we experienced two cases of hyperglycemic hyperosmolar coma in diabetic CAPD patients successfully treated with intravenous hydration and insulin therapy without discontinuing CAPD therapy. Because no such case has been reported, we report two cases of diabetic hyperosmolar coma with CAPD treated without conversion to HD. These cases suggest that adequate fluid replacement accompanying electrolytes and osmotic balance as well as insulin therapy might be a major role for safe treatment of hyperglycemic hyperosmolar coma in patient with CAPD.
Coma* ; Electrolytes ; Humans ; Hyperglycemia ; Insulin ; Kidney Failure, Chronic* ; Peritoneal Dialysis, Continuous Ambulatory* ; Renal Dialysis

The association between non-islet cell tumors and fasting hypoglycemia has been recognized since 1929. The humoral mediator of this non-islet cell tumor hypoglycemia(NICTH) is now known as IGF-II. Hypoglycemia develops commonly in the course of hepatocellular carcinoma(HCC), mostly late in the course and usually mild to moderate in severity. Rarely, severe hypoglycemia occurs early in the course of HCC, suggesting NICTH. We report a case of HCC in which hypoglycemic coma due to NICTH was the presenting symptom.A 52-year-old man developed mental confusion and seizures in the early morning. At emergency room, he was found to have severe hypoglycemia. Circulating levels of insulin, C-peptide, insulinlike growth factor-I(IGF-I) and growth hormone were reduced during hypoglycemia. Diagnostic work-up revealed that he had unresectable HCC. During admission, infusion of more than 400g of dextrose per day in addition to meals was required to prevent hypoglycemia. Because the chemotherapy was refused, he was transferred to a local hospital to receive infusions of dextrose.
Adenoma, Islet Cell ; C-Peptide ; Coma ; Drug Therapy ; Emergency Service, Hospital ; Glucose ; Growth Hormone ; Humans ; Hypoglycemia ; Insulin ; Insulin-Like Growth Factor II ; Islets of Langerhans ; Meals ; Middle Aged ; Seizures

Hypoglycemia is caused by poor oral intake, excessive exercise, alcohol abuse and inaccurate use of a hypoglycemic agent or insulin in patients that have history of diabetes mellitus (DM), especially in the elderly. Severe hypoglycemia has a variety of different symptoms or signs from focal neurologic deficits to severe coma, or death. It can be difficult to differentiate hypoglycemia-induced symptoms or signs, and stroke or cardiovascular disease in acute setting. Transient hypoglycemic hemiparesis is an infrequent case in the emergency department (ED), which is frequently misdiagnosed for stroke. When patients with decreased mental status or hemiparesis are admitted to the ED, a routine blood sugar test is essential. Hypoglycemic hemiparesis if unrecognized can result in permanent neurological damage. Therefore, it is important to detect hypoglycemia early and treat it appropriately.
Aged ; Alcoholism ; Blood Glucose ; Cardiovascular Diseases ; Coma ; Diabetes Mellitus ; Emergencies ; Humans ; Hypoglycemia ; Insulin ; Neurologic Manifestations ; Paresis ; Stroke

In 1957 Sament and Schwartz reported patient with profound coma and hyperglycemia but without ketonemia or acidosis. This syndrome in usually termed hyperosmolar hyperglycemic nonketotic coma(HHNC). Six critically ill patients while on the neurosurgical service were studied to establish the diagnosis of HHNC. Criteria for the diagnosis of HHNC included. 1) Serum glucose over than 220 mg/dl wigh glucosuria. 2) absence of significant acetonuria. 3) serum Na over than 150 mEq/l. 4) serum osmolarity over than 310 mOsM/kg. 5) neurological dysfunction. The production of the characteristic stupor and diminution of mental acuity appears to result from a decrease in intracellular water content within the brain due to the osmotic effects of those predominately extracellular substances. Factors documented to be significant in it's development include nonspecific stress to primary illness, hyperosmolar tube feeding. Dehydration, and mannitol, dilantin and steroid administration. The treatment of HHNC recommended the division of replacement into two stages: 1) rapid repair of water deficits which was calculated by described formula and correct the Na abnormality. 2) insulin replacement according to the degree of glucosuria. During the replacement therapy of water deficit and insulin, it should be necessary to repeat plasma electrolytes and blood glucose at 4 hour intervals until normal levels are approached. One among the 6 cases of HHNC became good recovery and 5 cases were expired on treatment, Fatal complications of this syndrome, such as acute renal failure, terminal arrhythmias and cardiopulmonary dysfunction, both cerebral and systemic, were common in these cases.
Acidosis ; Acute Kidney Injury ; Arrhythmias, Cardiac ; Blood Glucose ; Brain ; Coma ; Critical Illness ; Dehydration ; Diagnosis ; Electrolytes ; Enteral Nutrition ; Humans ; Hyperglycemia ; Hyperglycemic Hyperosmolar Nonketotic Coma* ; Insulin ; Ketosis ; Mannitol ; Osmolar Concentration ; Phenytoin ; Plasma ; Stupor ; Water

This review describes the types of psychiatric treatment studied during the Japanese colonial period of 1910–1945 in Korea, known at the time as Chosun. Twenty-nine research papers and abstracts on psychiatric treatment were reviewed, which were published in the Shinkeigaku-zassi (Neurologia), the Seishin-shinkei-gaku zassi (Psychiatria Et Neurologia Japonica) and the Journal of Chosun Medical Association, by faculty members of the department of neuropsychiatry, Chosun-Governor Hospital and Keijo (Seoul) Imperial University School of Medicine. The major research area was biological psychiatry and biological treatment, as Japanese pioneers in psychiatry at that time had introduced German psychiatry into Japan. Professor Kubo published the most papers, followed by Dr. Hattori, Dr. Hikari, and Professor Suits. In Chosun-Governor Hospital, research on prolonged sleep therapy was an active field. In the Imperial University Hospital, malarial fever therapy, sulphur-induced fever therapy, and insulin shock treatment were the most frequent research topics. Some were tried for the first time in the Japanese Empire, which reflected the pioneering position of the university. These achievements are attributed to Professor Kubo. Six papers on psychotherapy were published. Among them, two papers were on persuasion therapy, three papers were case reports of psychoanalytic therapy, and one paper on Freud. However, this psychoanalytic therapy research seemed to be limited trials conducted following literal guidance, and no further development was noted. Generally, research was characterized by simple design, small numbers of subjects, lack of objective evaluation method, lack of statistical treatment, and especially lack of ethical consideration comparing with today's standard.
Asian Continental Ancestry Group* ; Biological Psychiatry ; Humans ; Hyperthermia, Induced ; Insulin Coma ; Japan ; Korea* ; Methods ; Neuropsychiatry ; Persuasive Communication ; Psychiatry* ; Psychoanalytic Therapy ; Psychotherapy

During advanced prostate cancer, androgen deprivation therapy (ADT) using gonadotropin-releasing hormone and antiandrogen is an effective treatment modality. Recently, it has been reported that ADT may result in diabetes mellitus (DM), metabolic syndrome, and cardiovascular disease. Here, we report the first case in the literature of new-onset DM and hyperosmolar nonketotic coma (HNKC) associated with ADT. A 69-year-old man visited our hospital because of altered mentality. The patient had been taking leuprolide and bicalutamide for metastatic prostate cancer for the past 4 months. In laboratory tests, new-onset DM with HNKC was diagnosed. The patient was immediately treated with intravenous hydration and insulin therapy, and recovered without sequela. Because ADT can cause DM, or rarely HNKC, it is necessary to monitor fasting blood glucose and lipid profiles carefully while ADT is performed.
Aged ; Anilides ; Blood Glucose ; Cardiovascular Diseases ; Coma ; Diabetes Mellitus ; Fasting ; Gonadotropin-Releasing Hormone ; Humans ; Insulin ; Leuprolide ; Nitriles ; Organothiophosphorus Compounds ; Prostate ; Prostatic Neoplasms ; Tosyl Compounds

OBJECTIVE: The purpose of this study was to compare intensive insulin therapy and conventional therapy in terms of ventilator days, neurosurgical intensive care unit (NSICU) stay, Glasgow Outcome Scale (GOS), and complications for patients with a severe traumatic brain injury (TBI) who underwent decompressive craniectomy. METHODS: Patients who had a TBI and a Glasgow Coma Scale (GCS) score < or =8, and who had been treated with a unilateral or bilateral decompressive craniectomy were enrolled. Twenty-three patients were treated with intensive insulin therapy targeting 80-120 mg/dL of blood glucose level. For comparison, 17 patients with conventional insulin therapy (<200 mg/dL) were extracted from the historical data. RESULTS: There was no statistically significant difference in terms of sex, age, GCS at admission, diagnosis of TBI, and history of diabetes. There was no statistically significant difference between the conventional and intensive groups with respect to total days of mechanical ventilation, NSICU days, GOS, and pneumonia. Hypoglycemic episodes developed more frequently in the intensive insulin therapy group than in the conventional therapy group. CONCLUSION: Intensive insulin therapy with our protocol cannot be recommended over conventional therapy in patients with severe TBI.
Blood Glucose ; Brain Injuries ; Decompression ; Decompressive Craniectomy ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Humans ; Hyperglycemia ; Insulin ; Intensive Care Units ; Pneumonia ; Respiration, Artificial ; Ventilators, Mechanical