1,263 results match your criteria Hyperosmolar Coma


Multidisciplinary management of a traumatic posterior meningeal artery pseudoaneurysm: A case report and review of the literature.

Int J Surg Case Rep 2021 Apr 29;82:105933. Epub 2021 Apr 29.

Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA; University of South Florida, Tampa, FL, USA.

Background: Meningeal arterial injuries represent <1% of all blunt traumatic brain injuries (TBIs). Middle meningeal artery (MMA) lesions comprise the majority. However, there is little clinical data on posterior meningeal artery (PMA) injuries. Read More

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Hospitalization for Short-Term Diabetes-Related Complications: Focus on Patients Aged over 85 Years.

Healthcare (Basel) 2021 Apr 14;9(4). Epub 2021 Apr 14.

Department of Medicine and Ageing Sciences, "G. d'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy.

(1) : The prevalence of diabetes in elderly people is frequently high. When occurring in the elderly, diabetes is often accompanied by complications and comorbidities, at least one in 60% and four or more in 40% of older people with diabetes. As far as short-term complications among the elderly are concerned, hypoglycemia and hyperglycemic crises prove to be frequent. Read More

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Implementation of Multimodality Neurologic Monitoring Reporting in Pediatric Traumatic Brain Injury Management.

Neurocrit Care 2021 Mar 31. Epub 2021 Mar 31.

Department of Neurosciences, Barrow Neurological Institute At Phoenix Children's Hospital, 1919 E. Thomas Road, Ambulatory Building B, 3rd floor, Phoenix, AZ, 85016, USA.

Background/objective: Multimodality neurologic monitoring (MMM) is an emerging technique for management of traumatic brain injury (TBI). An increasing array of MMM-derived biomarkers now exist that are associated with injury severity and functional outcomes after TBI. A standardized MMM reporting process has not been well described, and a paucity of evidence exists relating MMM reporting in TBI management with functional outcomes or adverse events. Read More

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[Hyperosmolar Hyperglycemic State (HHS) with extreme hyperglycemia and hyperglycemia-induced hyponatremia in a patient with previously known diabetes mellitus type 2].

Lakartidningen 2021 03 26;118. Epub 2021 Mar 26.

överläkare, VO internmedicin, Visby lasarett.

This case report covers a patient presenting unconscious to the emergency department with a serum glucose level of 125.6 mmol/L and an associated hyperglycemia-induced hyponatremia with a sodium level of 101 mmol/L. The glucose level is, to our knowledge, one of the most extreme values described in medical literature. Read More

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Capecitabine-induced hyperosmolar hyperglycaemic state.

BMJ Case Rep 2021 Mar 24;14(3). Epub 2021 Mar 24.

Medicine, Division of Endocrinology, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada

An elderly woman with metastatic breast cancer was admitted with hyperglycaemic hyperosmolar state (HHS) and an elevated haemoglobin A1C. For 1 week, she had experienced confusion, nausea and frequent urination. Preceding this, she had completed seven cycles of capecitabine chemotherapy for her breast cancer. Read More

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Neurological Complications of Endocrine Emergencies.

Curr Neurol Neurosci Rep 2021 03 11;21(5):21. Epub 2021 Mar 11.

Department of Neurology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA.

Purpose Of Review: Endocrine disorders are the result of insufficient or excessive hormonal production. The clinical course is long, and the manifestations are nonspecific due to the systemic effect of hormones across many organs and systems including the nervous system. This is a narrative review of the recent evidence of the diagnosis and treatment approach of these medical and neurological emergencies. Read More

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50 Years Ago in TheJournalofPediatrics: Diazoxide-Induced Hyperosmolar Nonketotic Coma: Contemporary Genetic Insights.

J Pediatr 2021 03;230:31

Division of Neonatal-Perinatal Medicine, Women and Infant's Hospital of Rhode Island, Providence, Rhode Island.

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Hyperglycaemic hyperosmolar state: first presentation of type 1 diabetes mellitus in an adolescent with complex medical needs.

BMJ Case Rep 2021 Feb 4;14(2). Epub 2021 Feb 4.

Paediatrics, Northampton General Hospital NHS Trust, Northampton, Northamptonshire, UK.

This is a case of hyperglycaemic hyperosmolar state (HHS) as first presentation of type 1 diabetes mellitus in a 14-year-old girl with background complex medical needs. She presented with marked hyperglycaemia (56 mmol/L) without significant ketonaemia (2.6 mmol/L) and serum hyperosmolality (426 mOsm/kg). Read More

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February 2021

COVID-19 and emergencies in patients with diabetes: two case reports.

J Med Case Rep 2021 Feb 2;15(1):57. Epub 2021 Feb 2.

Department of Internal Medicine, Indira Gandhi Memorial Hospital, Male', Maldives.

Background: Maldives reported its first Coronavirus disease 2019 (COVID-19) case on March 7th, 2020. Since then more than 9400 positive cases and 33 deaths have been reported. Recently studies have shown that COVID-19 patients with diabetes had a poor prognosis and a higher mortality rate when compared to the non-diabetic patients. Read More

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February 2021

Reversible cerebral vasoconstriction syndrome associated with hyperosmolar hyperglycaemic state: A case report and literature review.

J Clin Neurosci 2021 Feb 6;84:38-41. Epub 2021 Jan 6.

Department of Neurosurgery, Royal Melbourne Hospital, 300 Grattan Street, Parkville, Victoria 3000, Australia; Department of Surgery, University of Melbourne, Parkville, VIC 3010, Australia. Electronic address:

Reversible cerebral vasoconstriction syndrome (RCVS) is an uncommon disorder characterised by thunderclap headache and self-resolving angiographic vasospasm in the presence or absence of neurological deficit. We present the first case of RCVS likely precipitated by a complex array of confounding factors including a hyperosmolar hyperglycaemic state (HHS), induction chemotherapy with cyclophosphamide, non-Hodgkin's lymphoma, pancytopenia and previous blood transfusions. However, the clinical presentation in this case of altered conscious state followed by thunderclap headache was highly suggestive of HHS being the crucial inciting factor. Read More

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February 2021

Ocular flutter and myoclonus in hyperosmolar hyperglycemic state.

Acta Neurol Belg 2021 Apr 10;121(2):595-596. Epub 2020 Nov 10.

Neurology Department, Leuven University Hospital, Leuven, Belgium.

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Traumatic Brain Injury Outcomes in 10 Asian Pediatric ICUs: A Pediatric Acute and Critical Care Medicine Asian Network Retrospective Study.

Pediatr Crit Care Med 2021 04;22(4):401-411

Duke-NUS Medical School, Singapore.

Objectives: Traumatic brain injury remains an important cause of death and disability. We aim to report the epidemiology and management of moderate to severe traumatic brain injury in Asian PICUs and identify risk factors for mortality and poor functional outcomes.

Design: A retrospective study of the Pediatric Acute and Critical Care Medicine Asian Network moderate to severe traumatic brain injury dataset collected between 2014 and 2017. Read More

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Focal Neurological Seizure due to Hyperglycemic Hyperosmolar Non-Ketotic Syndrome in Undiagnosed Diabetes Mellitus.

Cureus 2020 Aug 21;12(8):e9909. Epub 2020 Aug 21.

Pulmonary and Critical Care, Jersey Shore University Medical Center, Neptune City, USA.

Hyperglycemic hyperosmolar non-ketotic syndrome (HHNS) is a life-threatening complication of type 2 diabetes mellitus with a wide range of presenting symptoms. Neurological symptoms, such as coma, can also be part of the manifestation of HHNS; however, focal seizures remain a rare but notable association.  A 85-year-old male patient with no history of diabetes presented to our emergency department complaining of a two-day history of twitching movements of his left wrist. Read More

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Prehospital clinical signs are a poor predictor of raised intracranial pressure following traumatic brain injury.

Emerg Med J 2021 Jan 18;38(1):21-26. Epub 2020 Sep 18.

Air Ambulance Kent Surrey and Sussex, Redhill, Surrey, UK.

Background: For the prehospital diagnosis of raised intracranial pressure (ICP), clinicians are reliant on clinical signs such as the Glasgow Coma Score (GCS), pupillary response and/or Cushing's triad (hypertension, bradycardia and an irregular breathing pattern). This study aimed to explore the diagnostic accuracy of these signs as indicators of a raised ICP.

Methods: We performed a retrospective cohort study of adult patients attended by a Helicopter Emergency Medical Service (Air Ambulance Kent, Surrey Sussex), who had sustained a traumatic brain injury (TBI), requiring prehospital anaesthesia between 1 January 2016 and 1 January 2018. Read More

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January 2021

Left Homonymous Hemianopia: An Uncommon, Neuro-ophthalmological Presentation of Hyperglycemic Hyperosmolar State.

Am J Med Case Rep 2020 3;8(12):463-466. Epub 2020 Sep 3.

Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA.

Spectrum of the neurological deficits in non-ketotic hyperglycemia and hyperosmolar hyperglycemic state (HHS) ranges widely among patients and can have any presentation from focal seizures, epilepsia partialis continua, chorea-hemiballismus syndrome, hemiparesis, hemianopia to mental obtundation and coma. Here we report a case of HHS which presented with Left Homonymous Hemianopia as the only initial presentation. Symptoms slowly resolved over the course of two weeks by administration of insulin and normalizing the glucose. Read More

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September 2020

Predictions of diabetes complications and mortality using hba1c variability: a 10-year observational cohort study.

Acta Diabetol 2021 Feb 16;58(2):171-180. Epub 2020 Sep 16.

Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, People's Republic of China.

Introduction: Emerging evidence suggests that HbA1c variability, in addition to HbA1c itself, can be used as a predictor for mortality. The present study aims to examine the predictive power of mean HbA1c and HbA1c variability measures for diabetic complications as well as mortality.

Methods: The retrospective observational study analyzed diabetic patients who were prescribed insulin at outpatient clinics of the Prince of Wales Hospital and Shatin Hospital, Hong Kong, from 1 January to 31 December, 2009. Read More

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February 2021

Acute hyperosmolar hyperglycaemic state in cystic fibrosis-related diabetes caused by glucocorticoid and itraconazole interaction.

J Cyst Fibros 2021 Mar 11;20(2):330-332. Epub 2020 Sep 11.

Department of Paediatrics, University of Auckland, Auckland, New Zealand; Starship Children's Health, Auckland, New Zealand; Liggins institute, University of Auckland, New Zealand. Electronic address:

Hyperosmolar hyperglycaemic state (HHS) has not previously been reported in cystic fibrosis-related diabetes (CFRD). We report the case of a 15-year old boy with stable CFRD who developed acute HHS after treatment with glucocorticoids and itraconazole for presumed allergic broncho-pulmonary aspergillosis (ABPA). This case highlights the dangerous and preventable combination of high glucose intake, glucocorticoids and itraconazole inhibition of CYP3A4 (with resultant glucocorticoid accumulation) that can result in a state of life- threatening HHS in an adolescent with previously stable CFRD. Read More

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Management and Challenges of Severe Traumatic Brain Injury.

Semin Respir Crit Care Med 2021 Feb 11;42(1):127-144. Epub 2020 Sep 11.

Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, Nashville, Tennessee.

Traumatic brain injury (TBI) is the leading cause of death and disability in trauma patients, and can be classified into mild, moderate, and severe by the Glasgow coma scale (GCS). Prehospital, initial emergency department, and subsequent intensive care unit (ICU) management of severe TBI should focus on avoiding secondary brain injury from hypotension and hypoxia, with appropriate reversal of anticoagulation and surgical evacuation of mass lesions as indicated. Utilizing principles based on the Monro-Kellie doctrine and cerebral perfusion pressure (CPP), a surrogate for cerebral blood flow (CBF) should be maintained by optimizing mean arterial pressure (MAP), through fluids and vasopressors, and/or decreasing intracranial pressure (ICP), through bedside maneuvers, sedation, hyperosmolar therapy, cerebrospinal fluid (CSF) drainage, and, in refractory cases, barbiturate coma or decompressive craniectomy (DC). Read More

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February 2021

Clinical profile and outcomes in COVID-19 patients with diabetic ketoacidosis: A systematic review of literature.

Diabetes Metab Syndr 2020 Nov-Dec;14(6):1563-1569. Epub 2020 Aug 18.

Department of Hematology, Institute of Hematology and Transfusion Medicine, Medical College and Hospital, Kolkata, West Bengal, 700073, India.

Background And Aim: To conduct a systematic literature review and analyze the demographic/biochemical parameters and clinical outcomes of COVID-19 patients with diabetic ketoacidosis (DKA) and combined DKA/HHS (hyperglycemic hyperosmolar syndrome).

Methods: PubMed, Scopus, Embase, and Google Scholar databases were systematically searched till August 3, 2020 to identify studies reporting COVID-19 patients with DKA and combined DKA/HHS. A total of 19 articles reporting 110 patients met the eligibility criteria. Read More

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January 2021

Teaching NeuroImages: Nonketotic hyperglycemic hyperosmolar state mimicking acute ischemic stroke.

Neurology 2020 11 14;95(18):e2600-e2601. Epub 2020 Aug 14.

From the Departments of Neurology (M.I.B., A.C., M.S., F.G., P.B., R.R.) and Neuroradiology (L.A.M.), Hospital Británico de Buenos Aires, Argentina.

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November 2020

[Severe sensory-motor axonal neuropathy following diabetic ketoacidosis].

Rinsho Shinkeigaku 2020 Sep 8;60(9):614-619. Epub 2020 Aug 8.

Department of Neurology, Teikyo University School of Medicine.

We report a case of severe sensory-motor axonal neuropathy on the lower extremities associated with diabetic ketoacidosis (DKA). A sixteen-year-old boy developed coma and admitted to our hospital. We diagnosed him with DKA based on remarkable hyperglycemia, severe acidosis with hyperketonemia. Read More

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September 2020

[Aphasia as the presenting symptom of a hyperglycemic hyperosmolar state. Case report].

Rev Med Chil 2020 Apr;148(4):553-556

Departamento de Neurología Sur, Facultad de Medicina, Universidad de Chile, Santiago, Chile.

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Concurrent diabetic ketoacidosis with hyperosmolality and/or severe hyperglycemia in youth with type 2 diabetes.

Endocrinol Diabetes Metab 2020 Jul 15;3(3):e00160. Epub 2020 Jun 15.

Department of Pediatrics University of Alabama at Birmingham Birmingham AL USA.

Introduction: Prevalence of diabetic ketoacidosis (DKA) complicated by severe hyperglycaemia and hyperosmolality and its outcomes in youth with type 2 diabetes (T2DM) are not well-described. Our aim is to determine the frequency and clinical outcomes of isolated DKA, DKA with severe hyperglycaemia (DKA + SHG) and DKA with hyperglycaemia and hyperosmolality (DKA + HH) in youth with T2DM admitted for acute hyperglycaemic crisis.

Methods: Through retrospective medical record review, patients with T2DM were identified and categorized into isolated DKA, DKA + SHG (DKA + glucose ≥33. Read More

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[Anti-PD-1 therapy in advanced malignant liver tumor-induced type-1 diabetes mellitus: a case report].

Zhonghua Gan Zang Bing Za Zhi 2020 Jun;28(6):518-520

Affiliated Hospital of Hangzhou Normal University, Hangzhou 310011, China.

Immune checkpoint inhibitor (ICI) has been emerged as a major breakthrough in tumor immunotherapy, but its unique mechanism of action has also led to a number of immune-related adverse events (irAE). Type 1 diabetes mellitus (T1DM) is one of the rarest irAEs. This paper reports a case of advanced malignant liver tumor-induced T1DM who received second-line anti-PD-1 therapy and showed initial symptoms of hyperosmolar coma and hyperglycemia. Read More

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Clinical characteristics and outcome in patients with combined diabetic ketoacidosis and hyperosmolar hyperglycemic state associated with COVID-19: A retrospective, hospital-based observational case series.

Diabetes Res Clin Pract 2020 Aug 25;166:108279. Epub 2020 Jun 25.

Department of Medical Education, Saint Michael's Medical Centre, New York Medical College, NJ, United States; Department of Infectious Disease, Saint Michael's Medical Centre, New York Medical College, NJ, United States.

Aim: One of the risk factors for poor outcome with SARS-CoV-2 infection is diabetes mellitus; diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are the most serious complications of diabetes mellitus. We aimed to explore the clinical characteristics and outcomes of COVID-19 patients presenting with combined DKA/HHS to our institution.

Methods: A retrospective, hospital based observation case series was performed on patients with SARS-CoV-2 admitted to Intensive Care Unit between 3/20/2020 and 4/20/2020. Read More

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Pearls & Oy-sters: Bilateral globus pallidus lesions in a patient with COVID-19.

Neurology 2020 09 25;95(10):454-457. Epub 2020 Jun 25.

From the Department of Neurology (C.V.K.-S., J.L.M., A.R., M.A.G., B.L.C., K.A.D.), Department of Radiology (R.L.W., S.M., J.M.S., J.H.M., J.W.L.), Division of Pulmonary, Allergy, and Critical Care (D.G.D., J.E.M.), and Division of Infectious Diseases (M.Z.D., R.N.E.), Perelman School of Medicine at the University of Pennsylvania; and Division of Neurology (J.L.M.), the Children's Hospital of Philadelphia, PA.

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September 2020

Multicentre analysis of hyperglycaemic hyperosmolar state and diabetic ketoacidosis in type 1 and type 2 diabetes.

Acta Diabetol 2020 Oct 2;57(10):1245-1253. Epub 2020 Jun 2.

Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology (ZIBMT), Ulm University, Albert-Einstein-Allee 41, 89081, Ulm, Germany.

Aims: To compare diabetes patients with hyperglycaemic hyperosmolar state (HHS), diabetic ketoacidosis (DKA), and patients without decompensation (ND).

Methods: In total, 500,973 patients with type 1 or type 2 diabetes of all ages registered in the diabetes patient follow-up (DPV) were included. Analysis was stratified by age (≤ / > 20 years) and by manifestation/follow-up. Read More

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October 2020

Hemichorea-Hemiballismus as an Unusual Presentation of Hyperosmolar Hyperglycemic Syndrome.

Am J Med Case Rep 2020 5;8(6):159-161. Epub 2020 Apr 5.

Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY 11203 USA.

Diabetes mellitus can lead to a diverse array of systemic complications. Poorly managed hyperglycemia can result in serious neurological consequences ranging from peripheral neuropathy to seizures and coma. A rare neurologic disorder seen in acute decompensated type 2 diabetes mellitus (T2DM) is hemichorea-hemiballismus (HCHB). Read More

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