Conclusion: The patient followed up in good spirits. CBG was being monitored daily. Adherence to diet as well as lifestyle modification (stopped his alcohol intake and lessened meat intake) was remarkable. Laboratory results especially blood sugar control reached and exceeded target levels. The patient's proteinuria was fiurther evaluated. Twenty-four hour urine collection showed protein spillage but renal function was good. The plan is for continuous monitoring of this parameter. The patient's insulin (premixed 70/30) dose from an initial dose of 20-10 was adjusted until a maximum of 40-24 then reduced gradually. His present dose is 8-4.
HYPERGLYCEMIC

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

No abstract available.
Aspergillosis* ; Humans ; Hyperglycemic Hyperosmolar Nonketotic Coma ; Kidney Failure, Chronic* ; Sinusitis

No abstract available.
Aphasia, Broca* ; Diabetes Mellitus, Type 2 ; Hyperglycemic Hyperosmolar Nonketotic Coma

Acute Disease ; Glucocorticoids ; Graft Rejection ; Heart Rate ; Humans ; Hyperglycemic Hyperosmolar Nonketotic Coma ; Liver Transplantation

Hyperglycemic hyperosmolar state (HHS) is usually associated with type 2 diabetes mellitus (T2DM) with signigicant mortality and morbidity and is rare in pediatric population. The incidence of obesity and T2DM in children and adolescents is increasing at an alarming rate. With increasing rates of T2DM, the incidence of HHS may increase in pediatric population. HHS is characterized by severe hyperglycemia, a marked increase in serum osmolarity and clinical evidence of dehydration. The significance of HHS in children and adolescents remains largely unappreciated. We describe two obese adolescents with hyperglycemic hyperosmolar state at the onset of T2DM.
Adolescent ; Child ; Dehydration ; Diabetes Mellitus, Type 2 ; Humans ; Hyperglycemia ; Hyperglycemic Hyperosmolar Nonketotic Coma ; Incidence ; Obesity ; Osmolar Concentration

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

Hyperosmolar hyperglycemic syndrome (HHS) or hyperglycemic hyperosmolar nonketotic coma, an acute complication of type 2 diabetes mellitus, is commonly associated with hypernatremia. According to the treatment guideline of HHS and hypernatremia, plasma glucose and sodium concentration should be lowered at the recommended correction rate to prevent cerebral edema and, rarely, central pontine myelinolysis (CPM) or extrapontine myelinolysis (EPM). Recently we experienced a case of HHS with initial corrected serum sodium concentration of 198.5 mEq/L. The hypernatremia was corrected too rapidly on the first and second hospital days and the patient showed recent memory disturbance and difficulty in communication on the third hospital day. Brain MRI revealed abnormal signal intensities in the extrapontine areas, in favor of a diagnosis of EPM. We concluded that EPM of this case was induced by the rapid correction of hypernatremia.
Blood Glucose ; Brain ; Brain Edema ; Diabetes Mellitus, Type 2 ; Diagnosis ; Humans ; Hyperglycemic Hyperosmolar Nonketotic Coma ; Hypernatremia ; Magnetic Resonance Imaging ; Memory ; Myelinolysis, Central Pontine* ; Sodium

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

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.
Adult ; Brain/pathology ; Brain Edema/*etiology ; Case Report ; Human ; Hyperglycemic Hyperosmolar Nonketotic Coma/*complications ; Male ; Putaminal Hemorrhage/*etiology ; Tomography, X-Ray Computed