1,171 results match your criteria Hyperosmolar Coma
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
Emerg Med Clin North Am 2018 May 10;36(2):459-472. Epub 2018 Feb 10.
Department of Emergency Medicine, The University of Arizona, PO Box 245057, Tucson, AZ 85724-5057, USA; Department of Pediatrics, The University of Arizona, PO Box 245057, Tucson, AZ 85724-5057, USA.
Traumatic brain injury is a highly prevalent and devastating cause of morbidity and mortality in children. A rapid, stepwise approach to the traumatized child should proceed, addressing life-threatening problems first. Management focuses on preventing secondary injury from physiologic extremes such as hypoxemia, hypotension, prolonged hyperventilation, temperature extremes, and rapid changes in cerebral blood flow. Read More
Anaesth Crit Care Pain Med 2018 Jun 16;37 Suppl 1:S27-S30. Epub 2018 Mar 16.
Service d'anesthésie - réanimation chirurgicale, hôpitaux universitaires Paris-Sud, AP-HP, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France. Electronic address:
Follow on from continuous intravenous administration of insulin with an electronic syringe (IVES) is an important element in the postoperative management of a diabetic patient. The basal-bolus scheme is the most suitable taking into account the nutritional supply and variable needs for insulin, reproducing the physiology of a normal pancreas: (i) slow (long-acting) insulin (=basal) which should immediately take over from IVES insulin simulating basal secretion; (ii) ultra-rapid insulin to simulate prandial secretion (=bolus for the meal); and (iii) correction of possible hyperglycaemia with an additional ultra-rapid insulin bolus dose. A number of schemes are proposed to help calculate the dosages for the change from IV insulin to subcutaneous insulin and for the basal-bolus scheme. Read More
Dtsch Med Wochenschr 2018 Mar 15;143(6):384-391. Epub 2018 Mar 15.
Background: Diabetic ketoacidosis and the hyperosmolar hyperglycemic state are the most serious diabetic emergencies. Before the discovery of insulin in 1921 by Banting and Best the diagnosis of type 1 diabetes was fatal ending in diabetic ketoacidosis equivalent to a torturous death. Today, mortality from diabetic ketoacidosis is low at approximately 2 %. Read More
Am Fam Physician 2017 Dec;96(11):729-736
University of Illinois College of Medicine, Peoria, IL, USA.
Hyperosmolar hyperglycemic state is a life-threatening emergency manifested by marked elevation of blood glucose and hyperosmolarity with little or no ketosis. Although there are multiple precipitating causes, underlying infections are the most common. Other causes include certain medications, nonadherence to therapy, undiagnosed diabetes mellitus, substance abuse, and coexisting disease. Read More
J Stroke Cerebrovasc Dis 2018 Apr 3;27(4):1061-1067. Epub 2018 Jan 3.
Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.
Purpose: We aimed to identify the effect of hyperosmolar therapy (mannitol and hypertonic saline) on outcomes after intracerebral hemorrhage (ICH) in the Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study.
Methods: Comparison of ICH cases treated with hyperosmolar therapy versus untreated cases was performed using a propensity score based on age, initial Glasgow Coma Scale, location of ICH (lobar, deep, brainstem, and cerebellar), log-transformed initial ICH volume, presence of intraventricular hemorrhage, and surgical interventions. ERICH subjects with a pre-ICH modified Rankin Scale (mRS) score of 3 or lower were included. Read More
Crit Care 2017 12 28;21(1):328. Epub 2017 Dec 28.
Intensive Care Unit, Anaesthesia and Critical Care Department, Hôtel Dieu - HME, CHU Nantes, Nantes, France.
Background: Intracranial hypertension (ICH) is a major cause of death after traumatic brain injury (TBI). Continuous hyperosmolar therapy (CHT) has been proposed for the treatment of ICH, but its effectiveness is controversial. We compared the mortality and outcomes in patients with TBI with ICH treated or not with CHT. Read More
Pediatr Emerg Care 2017 Dec;33(12):e172-e174
We present the case of a 16-year-old boy who presented with fatigue, polyuria, and polydipsia while on chemotherapy for his relapsed acute lymphoblastic leukemia (ALL). Blood gas examination confirmed the diagnosis of hyperosmolar hyperglycemic state. The etiology for his hyperglycemia was most likely a result of oral glucocorticoid therapy combined with asparaginase therapy-both are a cornerstone of induction chemotherapy for ALL. Read More
Surg Clin North Am 2017 Oct;97(5):1015-1030
Division of Trauma, Surgical Critical Care, and Emergency General Surgery, Department of Surgery, Section of Surgical Sciences, Center for Health Services Research, Vanderbilt Brain Institute, Vanderbilt University Medical Center, 1211 21st Avenue South, Medical Arts Building, Suite 404, Nashville, TN 37212, USA; Surgical Services, Nashville Veterans Affairs Medical Center, Tennessee Valley Healthcare System, 1310 24th Avenue South, Nashville, TN 37212, USA. Electronic address:
Traumatic brain injury (TBI) is a leading cause of death and disability in patients with trauma. Management strategies must focus on preventing secondary injury by avoiding hypotension and hypoxia and maintaining appropriate cerebral perfusion pressure (CPP), which is a surrogate for cerebral blood flow. CPP can be maintained by increasing mean arterial pressure, decreasing intracranial pressure, or both. Read More
Rinsho Shinkeigaku 2017 10 28;57(10):591-594. Epub 2017 Sep 28.
Department of Neurology, Kasugai City Hospital.
We report the case of a 77-year-old woman with diabetic chorea, which presented as hemiballism of the right limbs. Initial blood examination revealed that sugar and hemoglobin A1c levels were 732 mg/dl and 12.2%, respectively. Read More
BMJ Open 2017 Sep 24;7(9):e018035. Epub 2017 Sep 24.
Anaesthesia Intensive Care Unit, Centre Hospitalier Universitaire, Nantes, France.
Introduction: Traumatic brain injury (TBI) is a major cause of death and severe prolonged disability. Intracranial hypertension (ICH) is a critical risk factor of bad outcomes after TBI. Continuous infusion of hyperosmolar therapy has been proposed for the prevention and the treatment of ICH. Read More
Internist (Berl) 2017 Oct;58(10):1020-1028
Präsidium der Universität zu Lübeck, Universität zu Lübeck, Lübeck, Deutschland.
The diabetic emergencies diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar state (HHS) and hypoglycemia represent severe and potentially life-threatening complications of diabetes mellitus that require prompt diagnostics and treatment. Absolute or relative insulin insufficiency is characteristic of DKA und HHS along with severe dehydration. They differ by the prevalence of ketone bodies and the severity of acidosis; however, the treatment regimens are similar. Read More
Emergencias 2017 07;29(4):245-248
Servicio de Endocrinología Hospital Universitario Río Hortega, Valladolid, España.
Objectives: To analyze the characteristics of acute diabetic complications attended in a hospital emergency department.
Material And Methods: Cross-sectional, descriptive, retrospective study of patients with hyper- and hypoglycemic emergencies attended in a tertiary-care university hospital emergency department.
Results: We included 237 patients with a mean (SD) age of 61 (26) years. Read More
World Neurosurg 2017 Oct 14;106:509-528. Epub 2017 Jul 14.
Division of Neurological Surgery, Department of Surgery, University of Toledo Medical Center, Toledo, Ohio, USA. Electronic address:
Objective: In neurotrauma care, a better understanding of treatments after traumatic brain injury (TBI) has led to a significant decrease in morbidity and mortality in this population. TBI represents a significant medical problem, and complications after TBI are associated with the initial injury and postevent intracranial processes such as increased intracranial pressure and brain edema. Consequently, appropriate therapeutic interventions are required to reduce brain tissue damage and improve cerebral perfusion. Read More
Eur Rev Med Pharmacol Sci 2017 Jun;21(11):2702-2707
Department of Endocrinology, Fujian Institute of Endocrinology, Union Hospital of Fujian Medical University Fuzhou, Fujian Province, China.
Objective: We analyzed the effects of intensive and mitigatory blood glucose control strategy on elderly people with type 2 diabetes mellitus (T2DM) combined with Alzheimer disease (AD).
Patients And Methods: We enrolled 90 elderly patients with T2DM combined with AD to participate in this study. They were randomly divided into 3 groups: the control group, the strength group and the mitigation group with 30 cases in each group. Read More
Medicine (Baltimore) 2017 Jun;96(25):e7369
Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.
Rationale: A hyperosmolar hyperglycemic state (HHS) is a rare presentation of a hyperglycemic crisis in children with diabetes mellitus. As this condition can be fatal and has high morbidity, early recognition and proper management are necessary for a better outcome. Here, we report a rare case of HHS as the first presentation of type 1 diabetes mellitus (T1DM) in a 7-year-old girl. Read More
Brain Nerve 2017 Jun;69(6):671-672
Department of Neurology, Tochigi Medical Center Shimotsuga.
Continuum (Minneap Minn) 2017 06;23(3, Neurology of Systemic Disease):778-801
Purpose Of Review: This article provides an overview of endocrine emergencies with potentially devastating neurologic manifestations that may be fatal if left untreated. Pituitary apoplexy, adrenal crisis, myxedema coma, thyroid storm, acute hypercalcemia and hypocalcemia, hyperglycemic emergencies (diabetic ketoacidosis and hyperglycemic hyperosmolar state), and acute hypoglycemia are discussed, with an emphasis on identifying the signs and symptoms as well as diagnosing and managing these clinical entities.
Recent Findings: To identify the optimal management of endocrine emergencies, using formal clinical diagnostic criteria and grading scales such as those recently proposed for pituitary apoplexy will be beneficial in future prospective studies. Read More
World Neurosurg 2017 Sep 27;105:238-248. Epub 2017 May 27.
Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA.
Background: Severe traumatic brain injury (TBI) is a major cause of death and disability worldwide. Prospective TBI data from sub-Saharan Africa are sparse. This study examines epidemiology and explores management of patients with severe TBI and adherence to Brain Trauma Foundation Guidelines at a tertiary care referral hospital in Tanzania. Read More
Crit Rev Clin Lab Sci 2017 06 10;54(4):219-232. Epub 2017 Apr 10.
b Marquette University School of Dentistry , Milwaukee , WI , USA.
Diabetes Mellitus (DM) is a group of metabolic diseases characterized by chronic high blood glucose concentrations (hyperglycemia). When it is left untreated or improperly managed, it can lead to acute complications including diabetic ketoacidosis and non-ketotic hyperosmolar coma. In addition, possible long-term complications include impotence, nerve damage, stroke, chronic kidney failure, cardiovascular disease, foot ulcers, and retinopathy. Read More
Med Clin North Am 2017 May;101(3):587-606
Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, 69 Jesse Hill Jr. Drive Southeast, 2nd Floor, Atlanta, GA 30303, USA. Electronic address:
Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are the most serious and life-threatening hyperglycemic emergencies in diabetes. DKA is more common in young people with type 1 diabetes and HHS in adult and elderly patients with type 2 diabetes. Features of the 2 disorders with ketoacidosis and hyperosmolality may coexist. Read More
Curr Diab Rep 2017 05;17(5):33
Division of Endo, Metabolism & Lipids, Emory University School of Medicine, Atlanta, GA, USA.
Purpose Of Review: Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are diabetic emergencies that cause high morbidity and mortality. Their treatment differs in the UK and USA. This review delineates the differences in diagnosis and treatment between the two countries. Read More
Int J Emerg Med 2017 Dec 21;10(1):12. Epub 2017 Mar 21.
Emergency Department, Centre Hospitalier Universitaire de Kigali, University of Rwanda, Butare, Rwanda.
Background: We report the ultrasound finding of ascariasis in a patient with hyperosmolar hyperglycemic state (HHS). Although ascariasis is common in low-resource settings, there has been no previous report associating ascariasis with HHS.
Case Presentation: A 26-year-old Rwandan man was admitted to the emergency department in coma, with a glycemia of 600 mg/dl. Read More
Semergen 2017 Sep 18;43(6):e57-e59. Epub 2017 Mar 18.
Hospital Regional Universitario de Málaga, Málaga, España.
Metabolism 2017 03 25;68:43-54. Epub 2016 Nov 25.
Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
Hyperglycaemic emergencies are associated with significant morbi-mortality and healthcare costs. Management consists on fluid replacement, insulin therapy, and electrolyte correction. However, some areas of patient management remain debatable. Read More
Turk J Emerg Med 2016 Jun 8;16(2):75-76. Epub 2016 May 8.
Dicle University, School of Medicine, Department of Endocrinology and Metabolism, Diyarbakir, Turkey.
Mediastinitis is a serious infection involving mediastinal spaces after cervical infections spread along the facial planes. A late diagnosis of mediastinitis may result in death. Here we present a diabetic patient suffered from mediastinit accompanied with hyperosmolar nonketotic coma. Read More
J Diabetes Investig 2017 May 6;8(3):392-394. Epub 2017 Jan 6.
Department of Endocrinology and Metabolism, Tsukuba University Hospital Mito Clinical Education and Training Center, Mito Kyodo General Hospital, Mito, Ibaraki, Japan.
A 27-year-old woman with panic disorder taking 20 mg olanzapine daily for 4 months was admitted to Mito Kyodo General Hospital, Mito, Ibaraki, Japan, because of disturbed consciousness with fever, hyperglycemia, hyperosmolarity and elevated creatine phosphokinase. She was diagnosed with a hyperosmolar hyperglycemic state and neuroleptic malignant syndrome. Brain magnetic resonance imaging showed transiently restricted diffusion in the splenium of the corpus callosum, with a high signal intensity on diffusion-weighted imaging. Read More
Nurse Pract 2016 Dec;41(12):1-4
Susan J. Appel is a professor at Capstone College of Nursing, University of Alabama, Tuscaloosa, Ala.
J Crit Care 2017 04 21;38:52-56. Epub 2016 Oct 21.
Pediatric Intensive Care Unit, "Aghia Sophia" Children's Hospital, Athens, Greece.
Purpose: Hyperosmolar therapies aim at controlling increased intracranial pressure (ICP) in patients with traumatic brain injury (TBI). The aim of this study was to evaluate the effect of 7.5% hypertonic saline (HTS) on ICP and cerebral perfusion pressure (CPP) in children with severe TBI. Read More
Methodist Debakey Cardiovasc J 2016 Sep;12(3):184-185
Houston Methodist Hospital, Houston, Texas.
Korean J Intern Med 2016 Nov 12;31(6):1187-1190. Epub 2016 Mar 12.
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Neurohospitalist 2016 Oct 5;6(4):157-160. Epub 2016 Apr 5.
Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
Intracranial pressure (ICP) monitoring frequently guides key decisions in the management of diseases causing intracranial hypertension. Although typically measured by invasive means, contraindications may leave the clinician with little recourse for dynamic ICP evaluation-particularly when the patient's mental status is compromised. We describe here a healthy 18-year-old woman who subacutely progressed to coma due to diffuse cerebral venous sinus thrombosis. Read More
Br J Hosp Med (Lond) 2016 Sep;77(9):C130-3
Consultant Physician in the Department of Endocrinology, Lister Hospital, Stevenage.
Pediatr Crit Care Med 2016 Nov;17(11):1064-1072
1Pediatric Critical Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT.2University of North Carolina Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC.3Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, NC.
Objective: To examine the use of intracranial pressure monitors and treatment for elevated intracranial pressure in children 24 months old or younger with traumatic brain injury in North Carolina between April 2009 and March 2012 and compare this with a similar cohort recruited 2000-2001.
Design: Prospective, observational cohort study.
Setting: Twelve PICUs in North Carolina. Read More
Neurol India 2016 Sep-Oct;64(5):958-61
Department of Neuroanesthesiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
Background: Intracranial pressure monitoring (ICP) is considered as optional for management of severe traumatic brain injury (TBI) in children.
Aims: This study was performed to determine whether ICP monitoring is beneficial in the managing severe TBI in children.
Settings And Design: Neurosurgical intensive care unit (ICU) of a tertiary care referral center; prospective observational study. Read More
Endocrinol Metab (Seoul) 2016 Sep 1;31(3):424-432. Epub 2016 Sep 1.
Department of Medicine, King George's Medical College, Lucknow, India.
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. Read More
Childs Nerv Syst 2016 Dec 27;32(12):2363-2368. Epub 2016 Aug 27.
Department of Critial Care, CHU Sainte-Justine, University de Montréal, 3175 Cote Sainte-Catherine, Montreal, Québec, H3T 1C5, Canada.
Objectives: The objectives of the study are to describe the use of hyperosmolar therapy in pediatric traumatic brain injury (TBI) and examine its effect on intracranial pressure (ICP) and cerebral perfusion pressure (CPP).
Design: A retrospective review of patients with severe TBI admitted to the pediatric intensive care unit (PICU) was conducted. Inclusion criteria were ICP monitoring and administration of a hyperosmolar agent (20 % mannitol or 3 % hypertonic saline) within 48 h of PICU admission; for which dose and timing were recorded. Read More
Nihon Naika Gakkai Zasshi 2016 Apr;105(4):690-7
J Diabetes 2017 Feb 31;9(2):208-209. Epub 2016 Aug 31.
Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Ischemic stroke is an uncommon complication among adults with DKA, that confers a worse prognosis. Traditional risk factors for stroke including older age, stroke history, hypertension and hyperlipidemia appear to predict the risk of IS in these patients. Demographic and clinical characteristics of patients with diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome patients, with and without cerebral edema. Read More
Environ Int 2016 09 6;94:642-648. Epub 2016 Jul 6.
Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan.
This study aimed to investigate the association of admissions for diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) with ambient temperature and season, respectively in patients with diabetes mellitus (DM), after excluding known co-morbidities that predispose onset of acute hyperglycemia events. This was a time series correlation analysis based on medical claims of 40,084 and 33,947 episodes of admission for DKA and HHS, respectively over a 14-year period in Taiwan. These episodes were not accompanied by co-morbidities known to trigger incidence of DKA and HHS. Read More
Vnitr Lek 2016 Jan;62(1):72-3
Vnitr Lek 2016 Jan;62(1):72
Nihon Rinsho 2016 Apr;74 Suppl 2:92-6
Arq Neuropsiquiatr 2016 Apr;74(4):354-5
Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
Am J Emerg Med 2016 Oct 17;34(10):2058.e1-2058.e2. Epub 2016 Mar 17.
Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Endocrinol Nutr 2016 May 22;63(5):252-3. Epub 2016 Mar 22.
Unidad de Metabolismo Infantil/Endocrinología Pediátrica, Hospital General Universitario Gregorio Marañón, Madrid, España.
Korean J Intern Med 2017 09 10;32(5):936-938. Epub 2016 Mar 10.
Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Nat Rev Endocrinol 2016 Apr 19;12(4):222-32. Epub 2016 Feb 19.
Division of Endocrinology and Metabolism, University of Pittsburgh, 3601 Fifth Avenue, Suite 560, Pittsburgh, Pennsylvania 15213, USA.
Diabetic ketoacidosis (DKA), hyperglycaemic hyperosmolar state (HHS) and hypoglycaemia are serious complications of diabetes mellitus that require prompt recognition, diagnosis and treatment. DKA and HHS are characterized by insulinopaenia and severe hyperglycaemia; clinically, these two conditions differ only by the degree of dehydration and the severity of metabolic acidosis. The overall mortality recorded among children and adults with DKA is <1%. Read More
BMJ Case Rep 2016 Jan 11;2016. Epub 2016 Jan 11.
Anaesthesia and Critical Care, Tameside Hospital NHS Foundation Trust, Lancashire, UK.
Decompensated hypothyroidism is a rare endocrine emergency but a differential that should be considered in patients presenting critically unwell with systemic illness. We report a case of myxoedema coma in a woman presenting with respiratory failure, hypotension, hypothermia and a reduced level of consciousness, all of which are poor prognostic features in decompensated hypothyroidism. The patient was admitted to critical care for mechanical ventilation and cardiovascular support and treated with a combination of insulin, liothyronine and levothyroxine, making a good recovery. Read More