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    Pediatric Major Head Injury: Not a Minor Problem.
    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

    Postoperative period.
    • Authors:
    Anaesth Crit Care Pain Med 2018 Mar 16. Epub 2018 Mar 16.
    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

    Hyperosmolar Hyperglycemic State.
    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

    Effect of Hyperosmolar Therapy on Outcome Following Spontaneous Intracerebral Hemorrhage: Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) Study.
    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

    Association between continuous hyperosmolar therapy and survival in patients with traumatic brain injury - a multicentre prospective cohort study and systematic review.
    Crit Care 2017 Dec 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

    Acute Management of Traumatic Brain Injury.
    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

    Effectiveness of levodopa treatment for diabetic chorea with reduced striatal accumulation in dopamine transporter SPECT: a case report.
    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

    COBI (COntinuous hyperosmolar therapy for traumatic Brain-Injured patients) trial protocol: a multicentre randomised open-label trial with blinded adjudication of primary outcome.
    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

    [Diabetic emergencies : Hypoglycemia, ketoacidotic and hyperglycemic hyperosmolar nonketotic coma].
    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

    [Acute diabetic complications attended in a hospital emergency department: a descriptive analysis].
    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

    A Comparison of Pharmacologic Therapeutic Agents Used for the Reduction of Intracranial Pressure After Traumatic Brain Injury.
    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

    Effect of different blood glucose intervention plans on elderly people with type 2 diabetes mellitus combined with dementia.
    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

    A case report of hyperosmolar hyperglycemic state in a 7-year-old child: An unusual presentation of first appearance of type 1 diabetes mellitus.
    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

    Endocrine Emergencies With Neurologic Manifestations.
    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

    Severe Traumatic Brain Injury at a Tertiary Referral Center in Tanzania: Epidemiology and Adherence to Brain Trauma Foundation Guidelines.
    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

    Evaluation of glycated albumin (GA) and GA/HbA1c ratio for diagnosis of diabetes and glycemic control: A comprehensive review.
    Crit Rev Clin Lab Sci 2017 Jun 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

    Management of Hyperglycemic Crises: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State.
    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

    Treatment of Diabetic Ketoacidosis (DKA)/Hyperglycemic Hyperosmolar State (HHS): Novel Advances in the Management of Hyperglycemic Crises (UK Versus USA).
    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

    Ascariasis and hyperosmolar hyperglycemic state: a surprising ultrasound finding in the emergency department.
    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

    Controversies in the management of hyperglycaemic emergencies in adults with diabetes.
    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

    A case of mediastinitis accompanied with hyperosmolar nonketotic coma.
    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

    Reversible splenial lesion syndrome with a hyperosmolar hyperglycemic state and neuroleptic malignant syndrome caused by olanzapine.
    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

    Effectiveness of 7.5% hypertonic saline in children with severe traumatic brain injury.
    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

    Continuous Qualitative Electroencephalography as a Noninvasive Neuromonitor.
    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

    Intracranial Pressure Monitoring in Infants and Young Children With Traumatic Brain Injury.
    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

    Is intracranial pressure monitoring useful in children with severe traumatic brain injury?
    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

    Prognostic Factors in Patients Hospitalized with Diabetic Ketoacidosis.
    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

    Hyperosmolar therapy in pediatric traumatic brain injury: a retrospective study.
    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

    Cerebral edema among adults with diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome: Incidence, characteristics, and outcomes.
    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

    Inverse relationship between ambient temperature and admissions for diabetic ketoacidosis and hyperglycemic hyperosmolar state: A 14-year time-series analysis.
    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

    Diabetic emergencies - ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia.
    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

    Myxoedema coma in the setting of hyperglycaemic hyperosmolar state.
    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

    Antipsychotic Therapy-Induced New Onset Diabetic Ketoacidosis.
    Am J Ther 2016 Nov/Dec;23(6):e1944-e1945
    1Department of Internal Medicine and Pediatrics, Western Michigan University Homer Stryker M.D., School of Medicine, Kalamazoo, MI; 2Department of Internal Medicine, Mayo Clinic Health System, Mankato, MN; and 3Department of Cardiology, Michigan State University, Borgess Medical Center, Kalamazoo, MI.
    Atypical antipsychotics are very widely used for various psychiatric ailments because of their less extrapyramidal side effects. Various reports of disturbances in glucose metabolism in the form of new onset diabetes mellitus, exacerbation of preexisting diabetes mellitus, diabetic ketoacidosis, hyperosmolar nonketotic coma, acute pancreatitis, and increased adiposity have been reported. We present a case of new onset diabetic ketoacidosis in a patient without a history of glucose intolerance who was being treated with olanzapine for bipolar disorder. Read More

    Demographic and Clinical Profiles of Type 2 Diabetes Mellitus Patients Initiating Canagliflozin Versus DPP-4 Inhibitors in a Large U.S. Managed Care Population.
    J Manag Care Spec Pharm 2015 Dec;21(12):1204-12
    HealthCore, 123 Justison St., Ste. 200, Wilmington, DE 19801.
    Background: Canagliflozin is the first sodium-glucose co-transporter-2 (SGLT-2) inhibitor-a new class of oral antidiabetic (OAD) medication-approved for type 2 diabetes mellitus (T2DM) treatment in the United States. Approved less than 2 years ago, use of canagliflozin is largely uncharacterized.

    Objective: To investigate and compare baseline demographic, clinical, and economic characteristics of patients initiating canagliflozin and dipeptidyl peptidase-4 (DPP-4) inhibitors in the real-world setting. Read More

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