3,323 results match your criteria Hyperosmolar Coma


Diagnosis, Clinical Trend, and Treatment of Diffuse Lamellar Keratitis after Femtosecond Laser-Assisted in situ Keratomileusis: A Case Report.

Case Rep Ophthalmol 2018 Sep-Dec;9(3):457-464. Epub 2018 Nov 14.

Balestrazzi Associated Ophthalmological Practice, Rome, Italy.

We report a severe case of diffuse lamellar keratitis (DLK) following femtosecond laser-assisted in situ keratomileusis (femto-LASIK). A 25-year-old man was submitted to 150 kHz iFS® IntraLase-assisted LASIK in both eyes for compound myopic astigmatism. The day after surgery, clinical examination showed a diffuse whitish granular cell reaction particularly in the right eye. Read More

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November 2018
6 Reads

Rhabdomyolysis-Induced Acute Kidney Injury in Diabetic Emergency: Underdiagnosed and an Important Association to Be Aware of.

Case Rep Med 2018 31;2018:4132738. Epub 2018 Oct 31.

Department of Medicine, Internal Medicine Residency Program, Hackensack Meridian Health, Jersey Shore University Medical Center, Neptune, New Jersey 07753, USA.

Rhabdomyolysis is a potentially life-threatening clinical syndrome associated with muscle injury which can cause a leakage of intracellular contents, manifested from the range of being asymptomatic to a life-threatening condition causing acute kidney injury and severe electrolyte abnormalities. Rhabdomyolysis has been associated with both diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic nonketotic syndrome, though there is an increased association with rhabdomyolysis and acute kidney injury with hyperosmolar nonketonic state compared with patients with diabetic ketoacidosis. Common clinical manifestations are muscle pain, dark urine, and generalized weakness. Read More

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October 2018
1 Read

Short-term Effect of Ambient Air Pollution on Emergency Department Visits for Diabetic Coma in Seoul, Korea.

J Prev Med Public Health 2018 Nov 29;51(6):265-274. Epub 2018 Oct 29.

Institute of Human Complexity and Systems Science, Yonsei University, Incheon, Korea.

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. Read More

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November 2018
1 Read

Therapeutic and preventative effects of ankaferd blood stopper in an experimental necrotizing enterocolitis model.

Biomed Pharmacother 2018 Nov 19;110:105-110. Epub 2018 Nov 19.

Division of Neonatology, Health Sciences University, Zekai Tahir Burak Maternity Education and Research Hospital, 06230, Ankara, Turkey. Electronic address:

Necrotizing enterocolitis (NEC) is a major neonatal health problem that especially affects preterm infants and causes severe morbidity and mortality. Although its pathogenesis is not fully understood, important risk factors include prematurity, oxidative stress, inflammation, and apoptosis. Ankaferd Blood Stopper® (ABS) has antioxidant, antiinflammatory, antimicrobial, antiapoptotic, and wound healing accelerant properties. Read More

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November 2018
4 Reads

Role of Hypertonic Sodium Lactate in Traumatic Brain Injury Management.

Asian J Neurosurg 2018 Oct-Dec;13(4):971-975

Department of Neurosurgery, Dr. Soetomo General Hospital / Faculty of Medicine - Airlangga University, Surabaya, Indonesia.

Traumatic brain injury (TBI) following increased intracranial pressure (ICP) is a neuroemergency case which should be managed promptly to prevent secondary brain injury. This will lead to a condition called cerebral energy dysfunction which is an important determinant factor toward worse outcome. Lactate, which was historically known as an end waste product, now is considered as an alternative cerebral energetic fuel. Read More

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November 2018
15 Reads

Evaluation of influence of infusion therapy on the dynamics of acid alkaline balance indices in patients with acute ischemic stroke.

Wiad Lek 2018 ;71(7):1316-1319

National Pirogov Memorial Medical University, Vinnytsya, Ukraine.

Objective: Introduction: The problem of the influence of infusion solutions on the correction of acid alkaline balance disorders in acute ischemic stroke (AIS) remains unclear. The aim: Compare the dynamics of changes acid alkaline balance (AAB) in the application of isosmolar 0.9% NaCl solution and hyperosmolar solution of mannitol in patients with acute ischemic stroke. Read More

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January 2018
4 Reads

Limb Ischemia in a Patient with Hyperosmolar Hyperglycemic State.

Clin Pract Cases Emerg Med 2018 Nov 17;2(4):348-352. Epub 2018 Oct 17.

University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland.

A 61-year-old male with a recent diagnosis of pemphigus vulgaris was brought to the emergency department for altered mental status. He had recently started taking prednisone to manage his autoimmune disease and had a progressive decline in his mental status along with decreased oral intake. Evaluation revealed hyperosmolar hyperglycemic state (HHS) and occlusive arterial thrombosis, a rare but known complication of HHS. Read More

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November 2018
2 Reads

Real-Time MRI Guidance for Reproducible Hyperosmolar Opening of the Blood-Brain Barrier in Mice.

Front Neurol 2018 26;9:921. Epub 2018 Oct 26.

Division of MR Research, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, United States.

The blood-brain barrier (BBB) prevents effective delivery of most therapeutic agents to the brain. Intra-arterial (IA) infusion of hyperosmotic mannitol has been widely used to open the BBB and improve parenchymal targeting, but the extent of BBB disruption has varied widely with therapeutic outcomes often being unpredictable. In this work, we show that real-time MRI can enable fine-tuning of the infusion rate to adjust and predict effective and local brain perfusion in mice, and thereby can be allowed for achieving the targeted and localized BBB opening (BBBO). Read More

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October 2018
3 Reads

Assessing and managing the acute complications of diabetes mellitus.

Nurs Stand 2018 Nov 6. Epub 2018 Nov 6.

Acute Medical Unit, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, England.

Nurses commonly encounter patients with type 1 or type 2 diabetes mellitus in their practice. Management of these conditions requires an in-depth knowledge of blood glucose monitoring. It is essential that nurses are aware of normal blood glucose levels, so that they can respond to complications caused by elevated and reduced blood glucose levels. Read More

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November 2018
4 Reads

An iso-osmolar oral supplement increases natriuresis and does not increase stomal output in patients with an ileostomy: A randomised, double-blinded, active comparator, crossover intervention study.

Clin Nutr 2018 Oct 24. Epub 2018 Oct 24.

Department of Hepatology and Gastroenterology, Aarhus University Hospital, DK-8200, Denmark. Electronic address:

Background: Patients with an ileostomy often experience fluid and electrolyte depletion because of gastrointestinal loss. This study aimed to compare how an iso-osmolar and a hyperosmolar oral supplement affect ileostomy output, urine production, and natriuresis as proxy measurements of water-electrolyte balance.

Methods: In a randomised, double-blinded, active comparator, crossover intervention study, we included eight adult ileostomy patients who were independent of parenteral support. Read More

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October 2018
11 Reads

Human iPSC-derived blood-brain barrier microvessels: validation of barrier function and endothelial cell behavior.

Biomaterials 2019 Jan 25;190-191:24-37. Epub 2018 Oct 25.

Institute for Nanobiotechnology, Johns Hopkins University, Baltimore, MD, United States; Department of Materials Science and Engineering, Johns Hopkins University, Baltimore, MD, United States. Electronic address:

Microvessels of the blood-brain barrier (BBB) regulate transport into the brain. The highly specialized brain microvascular endothelial cells, a major component of the BBB, express tight junctions and efflux transporters which regulate paracellular and transcellular permeability. However, most existing models of BBB microvessels fail to exhibit physiological barrier function. Read More

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January 2019
30 Reads
8.560 Impact Factor

An immune cell spray (ICS) formulation allows for the delivery of functional monocyte/macrophages.

Sci Rep 2018 Nov 2;8(1):16281. Epub 2018 Nov 2.

Institute of Experimental Hematology, Hannover Medical School, Hannover, Germany.

Macrophages are key cells of the innate immune system and act as tissue resident macrophages (TRMs) in the homeostasis of various tissues. Given their unique functions and therapeutic use as well as the feasibility to derive macrophages in vitro from hematopoietic stem cell (HSC) sources, we propose an "easy-to-use" immune cell spray (ICS) formulation to effectively deliver HSC-derived macrophages. To achieve this aim, we used classical pump spray devices to spray either the human myeloid cell line U937 or primary murine HSC-derived macrophages. Read More

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November 2018
27 Reads

Repeated rectal application of a hyperosmolar lubricant is associated with microbiota shifts but does not affect PrEP drug concentrations: results from a randomized trial in men who have sex with men.

J Int AIDS Soc 2018 Oct;21(10):e25199

Division of Infectious Diseases, Department of Medicine, The Hope Clinic of the Emory Vaccine Center, Emory University School of Medicine, Atlanta, GA, USA.

Introduction: Oral pre-exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC) is highly effective in preventing HIV infection among men who have sex with men (MSM). The effects of consistent personal lubricant use in the rectum on tissue PrEP drug concentrations and the rectal microbiota are unknown. We investigated rectal PrEP drug concentrations and the microbiota in MSM before and after repeated rectal application of a hyperosmolar lubricant. Read More

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October 2018
3 Reads
5.090 Impact Factor

The Protective Effect of (PCE) Aqueous Extract in a Dry Eye Model.

Nutrients 2018 Oct 19;10(10). Epub 2018 Oct 19.

Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon 34054, Korea.

Dry eyes are caused by highly increased osmolarity of tear film, inflammation, and apoptosis of the ocular surface. In this study, we investigated the effect of (PCE) aqueous extract in in vivo and in vitro dry eye models. Dry eye was induced by excision of the lacrimal gland and hyperosmotic media. Read More

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October 2018
4 Reads

FTY720 attenuates intestinal injury and suppresses inflammation in experimental necrotizing enterocolitis via modulating CXCL5/CXCR2 axis.

Biochem Biophys Res Commun 2018 Nov 9;505(4):1032-1037. Epub 2018 Oct 9.

Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, 215025, China. Electronic address:

Necrotizing enterocolitis (NEC) remains one of the leading causes of death in neonatal infants and new therapeutic strategies for NEC are urgently required. The immunomodulatory agent FTY720 has been shown to have protective effects in various inflammatory diseases. In this study, we hypothesized that treatment with FTY720 confers protection against experimental NEC. Read More

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November 2018
10 Reads

Glycogen Hepatopathy: A Rare and Underrecognized Cause of Recurrent Transaminitis in Patients with Uncontrolled Type 2 Diabetes Mellitus.

Case Rep Gastroenterol 2018 May-Aug;12(2):466-472. Epub 2018 Aug 23.

Division of Gastroenterology, Department of Medicine, Bronx Lebanon Hospital Center, Bronx, New York, USA.

Glycogen hepatopathy (GH), characterized by reversible transaminitis and hepatomegaly, results from excessive accumulation of glycogen in hepatocytes. GH has been well described in the literature as a rare cause of transaminitis in children and young patients with uncontrolled type 1 diabetes mellitus and has rarely been reported in type 2 diabetic patients. Hyperglycemia and hyperinsulinemia are believed to be a metabolic substrate for hepatic glycogen accumulation and in order to cause glycogen hepatotoxicity. Read More

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August 2018
9 Reads

New Insight into the Mechanism of Mannitol Effects on Cerebrospinal Fluid Pressure Decrease and Craniospinal Fluid Redistribution.

Neuroscience 2018 Nov 29;392:164-171. Epub 2018 Sep 29.

Department of Pharmacology and Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Zagreb, Croatia. Electronic address:

Intracranial hypertension, which often follows a severe brain injury, is usually treated with intravenous (i.v.) application of hyperosmolar solutions. Read More

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November 2018
7 Reads

Juvenile-onset gout and adipsic diabetes insipidus: A case report and literature review.

J Int Med Res 2018 Nov 1;46(11):4829-4836. Epub 2018 Oct 1.

1 Department of General Internal Medicine, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Science (CAMS) and Peking Union Medical College (PUMC), Beijing, China.

The prevalence of juvenile-onset gout has been increasing. Hereditary factors and secondary diseases should be considered in these patients. Adipsic diabetes insipidus (ADI) is characterized by arginine vasopressin (AVP) deficiency, which results in hypotonic polyuria, and dysfunction of thirst osmoreceptors, which results in failure to generate a thirst sensation in response to hypernatremia. Read More

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November 2018
8 Reads

Dornase alfa for cystic fibrosis.

Cochrane Database Syst Rev 2018 09 6;9:CD001127. Epub 2018 Sep 6.

Department of Pediatrics, Division of Respiratory Medicine, BC Children's Hospital, 4480 Oak Street, Vancouver, BC, Canada, V6H 3V4.

Background: Dornase alfa is currently used as a mucolytic to treat pulmonary disease (the major cause of morbidity and mortality) in cystic fibrosis. It reduces mucus viscosity in the lungs, promoting improved clearance of secretions. This is an update of a previously published review. Read More

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September 2018
12 Reads

Transvascular Delivery of Hydrophobically Modified siRNAs: Gene Silencing in the Rat Brain upon Disruption of the Blood-Brain Barrier.

Mol Ther 2018 Nov 8;26(11):2580-2591. Epub 2018 Aug 8.

RNA Therapeutics Institute, University of Massachusetts Medical School, Worcester, MA 01605, USA; Department of Molecular Medicine, University of Massachusetts Medical School, Worcester, MA 01605, USA. Electronic address:

Effective transvascular delivery of therapeutic oligonucleotides to the brain presents a major hurdle to the development of gene silencing technologies for treatment of genetically defined neurological disorders. Distribution to the brain after systemic administrations is hampered by the low permeability of the blood-brain barrier (BBB) and the rapid clearance kinetics of these drugs from the blood. Here we show that transient osmotic disruption of the BBB enables transvascular delivery of hydrophobically modified small interfering RNA (hsiRNA) to the rat brain. Read More

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November 2018
6 Reads
6.230 Impact Factor

A Retrospective Study of Intracranial Pressure in Head-Injured Patients Undergoing Decompressive Craniectomy: A Comparison of Hypertonic Saline and Mannitol.

Front Neurol 2018 31;9:631. Epub 2018 Jul 31.

Department of Neurosurgery, Suzhou Kowloon Hospital, Soochow University, Suzhou, China.

The impact of hypertonic saline (HTS) on the control of increased intracranial pressure (ICP) in head-injured patients undergoing decompressive craniectomy (DC) has yet to be established. The current retrospective study was conducted to compare the effect of HTS and mannitol on lowering the ICP burden of these patients. We reviewed data on patients who had sustained a traumatic brain injury (TBI) and were admitted to the First People's Hospital of Kunshan between January 1, 2012, and August 31, 2017. Read More

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July 2018
2 Reads

Increased Osmolarity in Biofilm Triggers RcsB-Dependent Lipid A Palmitoylation in .

MBio 2018 Aug 21;9(4). Epub 2018 Aug 21.

Institut Pasteur, Genetics of Biofilms Laboratory, Paris, France

Biofilms are often described as protective shelters that preserve bacteria from hostile surroundings. However, biofilm bacteria are also exposed to various stresses and need to adjust to the heterogeneous physicochemical conditions prevailing within biofilms. In Gram-negative bacteria, such adaptations can result in modifications of the lipopolysaccharide, a major component of the outer membrane characterized by a highly dynamic structure responding to environmental changes. Read More

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August 2018
13 Reads

Incidence and Outcomes of Non-ST Elevation Myocardial Infarction in Patients Hospitalized with Decompensated Diabetes.

Am J Cardiol 2018 Oct 17;122(8):1297-1302. Epub 2018 Jul 17.

Division of Cardiology, West Virginia University, Morgantown, West Virginia. Electronic address:

Single center studies suggested that non-ST elevation myocardial infarction (NSTEMI) in patients admitted with acute decompensated diabetes is associated with poor long-term prognosis. We hypothesize that acute decompensated diabetes is also associated with worse early morbidity and mortality in patients admitted with NSTEMI. Adult patients with a primary discharge diagnosis of diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS) were identified in the national inpatient sample. Read More

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October 2018
9 Reads

Cardiopulmonary bypass prime composition: beyond crystalloids versus colloids.

Perfusion 2018 Aug 16:267659118793249. Epub 2018 Aug 16.

2 Department of Public Health and Clinical Medicine, Heart Centre, Umeå University, Umeå, Sweden.

Introduction: In the literature addressing cardiopulmonary bypass (CPB) prime composition, there is a considerable lack of discussion concerning plasma osmolality changes induced by using a hyperosmolar prime. With this study, we try to determine the magnitude and temporal relationship of plasma osmolality changes related to the use of a hyperosmolar CPB prime.

Method: In this prospective observational study performed in a university hospital setting, we enrolled thirty patients scheduled for elective coronary bypass surgery. Read More

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August 2018
1 Read

Hyperglycemia crisis in head and neck cancer patients with platinum-based chemotherapy.

J Chin Med Assoc 2018 Dec 9;81(12):1060-1064. Epub 2018 Aug 9.

Department of Otolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC; School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC; Department of Otolaryngology, Head and Neck Surgery, Tri-Service General Hospital, Taipei, Taiwan, ROC. Electronic address:

Background: The development of a hyperglycemic crisis in platinum-based chemotherapy-treated head and neck cancer patients, such as hyperosmolar hyperglycemic state (HHS), has been reported. Hyperglycemic crises are associated with a high risk of comorbidity and may delay cancer treatment if not promptly managed.

Methods: This is a retrospective study using cancer registry data from a tertiary medical center. Read More

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December 2018
8 Reads

Hyperglycemia Syndromes.

Nurs Clin North Am 2018 Sep;53(3):303-317

Duke University School of Nursing, 307 Trent Drive, Durham, NC 27710, USA.

Diabetes mellitus and its complications are among the leading causes of organ failure around the world. It is imperative that timely, patient-centered care is provided to avoid microvascular and macrovascular damage. People with well-controlled diabetes can live long and healthy lives through interprofessional management, emphasizing optimal, individualized care. Read More

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September 2018
9 Reads

Successful Treatment of Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar Status in an Infant with KCNJ11-Related Neonatal Diabetes Mellitus via Continuous Renal Replacement Therapy.

Diabetes Ther 2018 Oct 9;9(5):2179-2184. Epub 2018 Aug 9.

Department of Endocrinology, Metabolism and Genetic Disorders, Children's Hospital of Soochow University, Suzhou, Jiangsu, China.

Neonatal diabetes mellitus (NDM) is a rare monogenic disorder presenting as uncontrolled hyperglycemia during the first 6 months of life. Hyperglycemic hyperosmolar state (HHS) is quite rare in NDM patients, and reported experience with this condition is limited. Continuous renal replacement therapy (CRRT) is frequently used as a mode of dialytic treatment in critically ill patients with acute renal failure, but has seldom been used in patients with diabetic ketoacidosis (DKA) and HHS. Read More

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October 2018
12 Reads

Pediatric Diabetic Ketoacidosis With Hyperosmolarity: Clinical Characteristics and Outcomes.

Endocr Pract 2018 08 7;24(8):726-732. Epub 2018 Aug 7.

Objective: Studies of hyperglycemic emergencies with hyperosmolality, including hyperglycemic hyperosmolar state (HHS) and "mixed presentation" with features of diabetic ketoacidosis (DKA) and HHS, are lacking in children. Objectives were to determine the incidence of DKA, HHS, and mixed presentation in a pediatric population, to characterize complications, and to assess accuracy of associated diagnosis codes.

Methods: Retrospective cohort study of 411 hyperglycemic emergencies in pediatric patients hospitalized between 2009 and 2014. Read More

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August 2018
11 Reads

The protective effects of sesamol in a neonatal rat model of necrotizing enterocolitis.

J Matern Fetal Neonatal Med 2018 Sep 27:1-6. Epub 2018 Sep 27.

b Department of Pediatric Surgery, Sisli Hamidiye Etfal Egitim ve Arastirma Hastanesi , Istanbul , Turkey.

Background And Aim: Necrotizing enterocolitis (NEC) is a severe gastrointestinal inflammatory disease associated with high rates of morbidity and mortality. Its pathophysiology includes hypoxic-ischemic injury that may be related to oxygen-derived free radical formation. Sesamol is considered to be an antioxidant and free radical scavenger with anti-inflammatory effects. Read More

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September 2018
2 Reads

Hyperosmolar Duodenal Saline Infusion Lowers Circulating Ghrelin and Stimulates Intestinal Hormone Release in Young Men.

J Clin Endocrinol Metab 2018 Dec;103(12):4409-4418

Discipline of Medicine and National Health and Medical Research Council Centre of Research Excellence in Nutritional Physiology, Interventions and Outcomes, University of Adelaide, Adelaide, South Australia, Australia.

Context: The mechanisms regulating the postprandial suppression of ghrelin secretion remain unclear, but recent observations in rats indicate that an increase in duodenal osmolarity is associated with a reduction in ghrelin levels. Several hormones have been implicated in the regulation of ghrelin.

Objective: We hypothesized that intraduodenal infusion of a hyperosmolar solution would lower plasma ghrelin concentrations. Read More

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December 2018
5 Reads

Hypertonic Stress Causes Cytoplasmic Translocation of Neuronal, but Not Astrocytic, FUS due to Impaired Transportin Function.

Cell Rep 2018 Jul;24(4):987-1000.e7

Institute of Molecular Life Sciences, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland; Life Science Zurich Graduate School, University of Zurich and ETH Zurich, Zurich, Switzerland. Electronic address:

The primarily nuclear RNA-binding protein FUS (fused in sarcoma) forms pathological cytoplasmic inclusions in a subset of early-onset amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD) patients. In response to cellular stress, FUS is recruited to cytoplasmic stress granules, which are hypothesized to act as precursors of pathological inclusions. We monitored the stress-induced nucleocytoplasmic shuttling of endogenous FUS in an ex vivo mouse CNS model and human neural networks. Read More

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July 2018
5 Reads

Blue light phototoxicity toward human corneal and conjunctival epithelial cells in basal and hyperosmolar conditions.

Free Radic Biol Med 2018 Oct 21;126:27-40. Epub 2018 Jul 21.

Sorbonne Université, INSERM, CNRS, Institut de la Vision, Paris, France; Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France; CHU Robert Debré, Université Reims Champagne-Ardenne, Reims, France.

Aims: The ocular surface is the very first barrier between the visual system and external environment. It protects the eye from the exposure to various light sources that significantly emit in blue spectrum. However, the impact of blue light on the ocular surface has been poorly explored so far. Read More

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October 2018

Impact of acute diabetes decompensation on outcomes of diabetic patients admitted with ST-elevation myocardial infarction.

Diabetol Metab Syndr 2018 17;10:57. Epub 2018 Jul 17.

2Division of Cardiology, West Virginia University, Morgantown, WV USA.

Background: Acute hyperglycemia is associated with worse outcomes in diabetic patients admitted with ST-elevation myocardial infarction (STEMI). However, the impact of full-scale decompensated diabetes on STEMI outcomes has not been investigated.

Methods: We utilized the national inpatient sample (2003-2014) to identify adult diabetic patients admitted with STEMI. Read More

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July 2018
9 Reads

The Effect of Fluid Loading and Hypertonic Saline Solution on Cortical Cerebral Microcirculation and Glycocalyx Integrity.

J Neurosurg Anesthesiol 2018 Jul 13. Epub 2018 Jul 13.

Departments of Anesthesiology and Intensive Care Medicine.

Background: Fluid loading and hyperosmolar solutions can modify the cortical brain microcirculation and the endothelial glycocalyx (EG). This study compared the short-term effects of liberal fluid loading with a restrictive fluid intake followed by osmotherapy with hypertonic saline (HTS) on cerebral cortical microcirculation and EG integrity in a rabbit craniotomy model.

Methods: The experimental rabbits were allocated randomly to receive either <2 mL/kg/h (group R, n=14) or 30 mL/kg/h (group L, n=14) of balanced isotonic fluids for 1 hour. Read More

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July 2018
5 Reads

Addition of hyaluronic acid improves tolerance to 7% hypertonic saline solution in bronchiectasis patients.

Ther Adv Respir Dis 2018 Jan-Dec;12:1753466618787385

La Fe University Hospital, Valencia, Spain.

Background: The excessive retention of sputum in the airways, leading to pulmonary infections, is a common consequence of bronchiectasis. Although inhalation of 7% hypertonic saline (HS) has proven an effective method to help remove the mucus, many patients are intolerant of this treatment. The addition of 0. Read More

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July 2018
11 Reads

Delirium and Psychotic Symptoms Associated with Hyperglycemia in a Patient with Poorly controlled Type 2 Diabetes Mellitus.

Innov Clin Neurosci 2018 Jun;15(5-6):30-33

Dr. Lopes is with the Faculty of Medicine at the University of Porto in Porto, Portugal.

Delirium, acute confusional states, and secondary psychosis have been associated with several medical conditions, including endocrine disorders. In the context of diabetes mellitus (DM), it has been mostly related to hypoglycemia and rarely occurs in association with hyperglycemia, outside of the context of a hyperglycemic hyperosmolar state or diabetic ketoacidosis. Here, we describe a case of delirium and psychotic symptoms associated with hyperglycemia in a patient with poorly controlled Type 2 DM as an attempt to alert clinicians to this rare association. Read More

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June 2018
19 Reads

Osmotic demyelination syndrome due to hyperosmolar hyperglycemia.

Cleve Clin J Med 2018 Jul;85(7):511-513

Chairman, Department of Diagnostic and Generalist Medicine, Dokkyo Medical University, Tochigi, Japan.

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July 2018
3 Reads

Central Pontine Myelinolysis in Pediatric Diabetic Ketoacidosis.

Case Rep Crit Care 2018 4;2018:4273971. Epub 2018 Jun 4.

Department of Pediatric Critical Care, Kapiolani Medical Center for Women & Children, USA.

Central pontine myelinolysis (CPM) is rarely reported in pediatric patients with diabetic ketoacidosis (DKA). We report this case of a 16-year-old female with new onset diabetes presenting with DKA, who received aggressive fluid resuscitation and sodium bicarbonate in the emergency department. Later she developed altered mental status concerning for cerebral edema and received hyperosmolar therapy with only transient improvement. Read More

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June 2018
24 Reads

Diazoxide toxicity in a child with persistent hyperinsulinemic hypoglycemia of infancy: mixed hyperglycemic hyperosmolar coma and ketoacidosis.

J Pediatr Endocrinol Metab 2018 Aug;31(8):943-945

Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

Background: Persistent hyperinsulinemic hypoglycemia of infancy (PHHI), also known as congenital hyperinsulinism, has been known to go into spontaneous remission, with patients developing diabetes in later life. A temporary phase of hyperglycemia is, however, rarely reported.

Case Presentation: We describe a 16-month-old child, a known case of diazoxide responsive PHHI, presenting with mixed hyperglycemic hyperosmolar coma and ketoacidosis with rhabdomyolysis while on diazoxide treatment. Read More

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August 2018
9 Reads

Validation of Predicting Hyperglycemic Crisis Death Score: A Risk Stratification Tool for Appropriate Disposition of Hyperglycemic Crisis Patients from the Emergency Department.

J Emerg Trauma Shock 2018 Apr-Jun;11(2):104-110

Department of Emergency Medicine, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India.

Context: Predicting hyperglycemic crisis death (PHD) score is a simple, rapid tool with six independent mortality predictors to calculate 30-day mortality and appropriately dispose patients to Intensive Care Unit (ICU) or ward.

Aims: This study aimed at validating the efficiency of PHD score as a decision rule for prognosticating 30-day mortality and classifying hyperglycemic crisis patients for appropriate disposition from the emergency department (ED).

Materials And Methods: This is a prospective, observational study done in the ED of a teaching hospital over 14 months. Read More

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June 2018
10 Reads

Hypertonic saline or mannitol for treating elevated intracranial pressure in traumatic brain injury: a meta-analysis of randomized controlled trials.

Neurosurg Rev 2018 Jun 15. Epub 2018 Jun 15.

Department of Neurosurgery, The First Affiliated Hospital of Shantou University Medical College, Changping Rd, Shantou, 515041, Guangdong, China.

Hyperosmolar therapy is regarded as the mainstay for treatment of elevated intracranial pressure (ICP) in traumatic brain injury (TBI). This still has been disputed as application of hypertonic saline (HS) or mannitol for treating patients with severe TBI. Thus, this meta-analysis was performed to further compare the advantages and disadvantages of mannitol with HS for treating elevated ICP after TBI. Read More

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June 2018
13 Reads

Atypical postictal transient subcortical T2 hypointensity in a newly diagnosed diabetic patient with seizures.

Epileptic Disord 2018 Jun;20(3):209-213

Department of Neuroradiology, IRCCS Istituto Neurologico Casimiro Mondino, Pavia,, Department of Brain and Behavioral Sciences, University of Pavia.

Common postictal MRI findings include transient cortical T2 hyperintensity, restricted diffusion, and gyral and/or adjacent leptomeningeal contrast enhancement. In certain uncommon pathological conditions, other signal abnormalities can be present, suggesting a different underlying pathogenic mechanism. We report the case of a 66-year-old man, recently diagnosed with diabetes mellitus type 2, presenting with new-onset visual and auditory hallucinations, "absence" seizures, and repeated peaks of hyperglycaemia without hyperketonaemia or increased serum osmolarity. Read More

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June 2018
1 Read

ISPAD Clinical Practice Consensus Guidelines 2018: Diabetic ketoacidosis and the hyperglycemic hyperosmolar state.

Pediatr Diabetes 2018 Oct;19 Suppl 27:155-177

Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile.

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October 2018
25 Reads

Evaluation of Risk of Injury by Extravasation of Hyperosmolar and Vasopressor Agents in a Rat Model.

Biol Pharm Bull 2018 ;41(6):951-956

Department of Pharmaceutical Services, Hiroshima University Hospital.

Inadvertent leakage of noncytotoxic agents causes severe tissue injury. In this study, we macroscopically and histopathologically evaluated the extent of skin injury caused by extravasation of hyperosmolar or vasopressor agents in rats. Rats were intradermally administered saline (100 µL), the hyperosmolar agents mannitol (5-20 mg/100 µL) and glucose (5-50 mg/100 µL), or the vasopressors dopamine (2 mg/100 µL), adrenaline (0. Read More

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October 2018
8 Reads

Associations of hyperosmolar medications administered via nasogastric or nasoduodenal tubes and feeding adequacy, food intolerance and gastrointestinal complications amongst critically ill patients: A retrospective study.

Clin Nutr ESPEN 2018 Jun 17;25:78-86. Epub 2018 Apr 17.

Department of Intensive Care Medicine, Gelderse Vallei Hospital, Willy Brandtlaan 10, 6716, Ede, The Netherlands. Electronic address:

Background: Adequate nutrition is essential during critical illness. However, providing adequate nutrition is often hindered by gastro-intestinal complications, including feeding intolerance. It is suggested that hyperosmolar medications could be causally involved in the development of gastro-intestinal complications. Read More

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June 2018
13 Reads

Risperidone-induced type 2 diabetes presenting with diabetic ketoacidosis.

Endocrinol Diabetes Metab Case Rep 2018 10;2018. Epub 2018 May 10.

Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland.

A 28-year-old male presented with 2 days of vomiting and abdominal pain, preceded by 2 weeks of thirst, polyuria and polydipsia. He had recently started risperidone for obsessive-compulsive disorder. He reported a high dietary sugar intake and had a strong family history of type 2 diabetes mellitus (T2DM). Read More

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May 2018
6 Reads

Recurrent hospitalizations for severe hypoglycemia and hyperglycemia among U.S. adults with diabetes.

J Diabetes Complications 2018 Jul 24;32(7):693-701. Epub 2018 Apr 24.

Division of Health Care Policy & Research, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, 200 First Street SW, Rochester, MN 55905, United States; OptumLabs, 1 Main Street, 10th Floor, Cambridge, MA 02142, United States.

Aims: Examine 30-day readmissions for recurrent hypoglycemia and hyperglycemia in a national cohort of adults with diabetes.

Methods: Retrospective analysis of data from OptumLabs Data Warehouse for all adults with diabetes hospitalized January 1, 2009 to December 31, 2014 with a principal diagnosis of hypoglycemia or hyperglycemia. We examined the rates and risk factors of 30-day readmissions for hypoglycemia and hyperglycemia. Read More

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July 2018
4 Reads

One too many diabetes: the combination of hyperglycaemic hyperosmolar state and central diabetes insipidus.

Endocrinol Diabetes Metab Case Rep 2018 11;2018. Epub 2018 Apr 11.

Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland.

The combination of hyperosmolar hyperglycaemic state and central diabetes insipidus is unusual and poses unique diagnostic and therapeutic challenges for clinicians. In a patient with diabetes mellitus presenting with polyuria and polydipsia, poor glycaemic control is usually the first aetiology that is considered, and achieving glycaemic control remains the first course of action. However, severe hypernatraemia, hyperglycaemia and discordance between urine-specific gravity and urine osmolality suggest concurrent symptomatic diabetes insipidus. Read More

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April 2018
6 Reads

Early Administration of Hypertonic-Hyperoncotic Hydroxyethyl Starch (HyperHES) Improves Cerebral Blood Flow and Outcome After Experimental Subarachnoid Hemorrhage in Rats.

World Neurosurg 2018 Aug 5;116:e57-e65. Epub 2018 Apr 5.

Department of Neurosurgery, University Hospital Wuerzburg, Wuerzburg, Germany.

Objective: Early cytotoxic brain edema may be a decisive factor that maintains cerebral malperfusion after subarachnoid hemorrhage (SAH). In addition, endothelial cell swelling may be an independent factor restricting cerebral blood flow (CBF) in a very early stage after SAH. Immediate and aggressive treatment may be able to restore CBF in this critical period. Read More

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August 2018
1 Read