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    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 Apr 10:1-14. 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

    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

    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

    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

    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

    Case report: severe reversible cardiomyopathy associated with systemic inflammatory response syndrome in the setting of diabetic hyperosmolar hyperglycemic non-ketotic syndrome.
    BMC Cardiovasc Disord 2015 Oct 14;15:123. Epub 2015 Oct 14.
    Department of Internal Medicine, Texas Tech University Health Sciences Center, School of Medicine, 3601 4th St Stop 9410, Lubbock, TX, 79416, USA.
    Background: This case study features a woman who presented with clinical and laboratory findings consistent with hyperosmolar hyperglycemic non-ketotic syndrome (HHNS), systemic inflammatory response syndrome (SIRS), and non-thyroidal illness syndrome (NTIS) who was noted to have a transient decrease in myocardial function. To our knowledge, this is the first case discussing the overlapping pathophysiological mechanisms could increase susceptibility to SIRS-induced cardiomyopathy. It is imperative that this clinical question be investigated further as such a relationship may have significant clinical implications for prevention and future treatments, particularly in patients similar to the one presented in this clinical case. Read More

    Diabetes in older people.
    Clin Med (Lond) 2015 Oct;15(5):465-7
    University Hospital Aintree, Liverpool, UK.
    The management of diabetes in older people is often challenging and poorly researched. The prevalence of cognitive impairment, chronic kidney disease and other co-existing comorbidities increase with age and have a significant impact on glycaemic control targets and treatment options. This conference examined current clinical practice, highlighted differences in the management of diabetes in the older person and suggested potential areas of future research. Read More

    Hyperglycaemic hyperosmolar syndrome in children: Patient characteristics, diagnostic delays and associated complications.
    J Paediatr Child Health 2016 Jan 30;52(1):80-4. Epub 2015 Jul 30.
    Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, United States.
    Aims: The aim of this study was to describe the demographical and clinical characteristics, diagnostic difficulties, and morbidity and mortality in children with hyperglycaemic hyperosmolar syndrome (HHS).

    Methods: Retrospective cross-section descriptive study of children (<18 years of age) at an urban, tertiary, academic Children's Hospital diagnosed with HHS from January 2002 to December 2011.

    Results: Six patients met inclusion criteria for the diagnosis of HHS. Read More

    Urinary incontinence a first presentation of central pontine myelinolysis: a case report.
    Age Ageing 2015 Sep 23;44(5):898-900. Epub 2015 Jul 23.
    Ipswich Hospital, Ipswich, UK.
    An 84-year-old lady was treated for hyperosmolar hyperglycaemia with IV insulin, fluids and catheterisation for fluid balance monitoring. Trial without catheter failed as the patient complained of new-onset urinary incontinence and lack of awareness of bladder filling. In light of her breast cancer history, we excluded cauda equina. Read More

    [Successful treatment of extreme hypernatremia by continuous veno-venous hemodiafiltration].
    Nephrol Ther 2015 Nov 11;11(6):492-5. Epub 2015 Jul 11.
    Pôle réanimation-anesthésie-Samu, réanimation chirurgicale, CHU Charles Nicolle, 1, rue de Germont, 76031 Rouen, France.
    Extreme hypernatremia in intensive care unit are frequently associated with a poor prognosis and their treatment, when associated with acute renal failure, is not consensual. We report the case of a 39-year-old man admitted in our intensive care unit for coma who presented extreme hyperosmolar hypernatremia (sodium 180 mmol/L, osmolarity 507 mOsm/L) associated with acute renal failure (urea 139.3 mmol/L, creatinine 748 μmol/L) and many other metabolic abnormalities. Read More

    Efficacy and Safety of Continuous Micro-Pump Infusion of 3% Hypertonic Saline combined with Furosemide to Control Elevated Intracranial Pressure.
    Med Sci Monit 2015 Jun 17;21:1752-8. Epub 2015 Jun 17.
    Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China (mainland).
    Background: Elevated intracranial pressure is one of the most common problems in patients with diverse intracranial disorders, leading to increased morbidity and mortality. Effective management for increased intracranial pressure is based mainly on surgical and medical techniques with hyperosmolar therapy as one of the core medical treatments. The study aimed to explore the effects of continuous micro-pump infusions of 3% hypertonic saline combined with furosemide on intracranial pressure control. Read More

    [Hyperosmolar hyperglycemic state].
    Vnitr Lek 2015 May;61(5):451-7
    The hyperglycemic hyperosmolar state (HHS) is a serious acute complication of diabetes decompensation, especially in type 2 diabetes (T2DM), and with critical prognosis. Primary characteristics of HHS include extreme hyperglycemia, severe dehydration (with prerenal hyperazotaemia), plasma hyperosmolarity, frequent disorders of consciousness, absent or minimum ketoacidosis (with higher values, only found in combined forms). Both DKA and HHS have a common pathogenetic mechanism, but both states are opposite extreme deviations, and the boundaries between them are not entirely clear. Read More

    The Prevalence and Impact of Hyperglycemia and Hyperlipidemia in Patients With Advanced Cancer Receiving Combination Treatment With the Mammalian Target of Rapamycin Inhibitor Temsirolimus and Insulin Growth Factor-Receptor Antibody Cixutumumab.
    Oncologist 2015 Jul 8;20(7):737-41. Epub 2015 Jun 8.
    Departments of Endocrine Neoplasia and Hormonal Disorders, Head and Neck Surgery, Biostatistics, and Investigational Cancer Therapeutics (Phase I Clinical Trials Program), The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, Michigan, USA; Cancer Therapy Evaluation Program, National Institutes of Health/National Cancer Institute, Rockville, Maryland, USA; Center for Personalized Cancer Therapy, University of California, San Diego, Moores Cancer Center, La Jolla, California, USA
    Background: Cixutumumab (a humanized monoclonal antibody against insulin-like growth factor-1 receptor [IGF-1R]) and the mammalian target of rapamycin (mTOR) inhibitor temsirolimus were combined in a phase I study of patients with advanced cancer. We investigated the prevalence of metabolic toxicities, their management, and impact on outcome.

    Methods: The temsirolimus dose was 25 mg or 37. Read More

    Diabetes mellitus and Ramadan in elderly patients.
    J Pak Med Assoc 2015 May;65(5 Suppl 1):S33-6
    Department of Endocrinology and Metabolic Diseases, Bab El Oued Teaching Hospital, University of Medicine, Algiers, Algeria.
    Worldwide, the proportion of people above 60 years old represents 15% of the whole population. Diabetes mellitus is more frequent in this age group, and is associated with increased risk of morbidities and premature mortality. Aged Muslim people with diabetes insist on fasting during Ramadan, for many reasons. Read More

    Promotive effect of comprehensive management on achieving blood glucose control in senile type 2 diabetics.
    Genet Mol Res 2015 Apr 10;14(2):3062-70. Epub 2015 Apr 10.
    Department of Geriatric Endocrinology, PLA General Hospital, Beijing, China
    The aim of this study was to evaluate the control of blood glucose and glycosylated hemoglobin A1c (HbA1c) and its influencing factors, in elderly type 2 diabetic mellitus (T2DM) patients undergoing comprehensive management. After years of comprehensive prevention of and control measures for diabetes, elderly T2DM patients who were receiving long-term health care were comprehensively evaluated through an annual physical examination. In addition to routine health examination, the patients were required to undergo HbA1c measurement. Read More

    Prolonged hypernatremia triggered by hyperglycemic hyperosmolar state with coma: A case report.
    World J Nephrol 2015 May;4(2):319-23
    Darlene Vigil, Yijuan Sun, Antonios H Tzamaloukas, Karen S Servilla, Nephrology Section, Medicine Service, Raymond G Murphy Veterans Affairs Medical Center, Albuquerque, NM 87108, United States.
    A man with past lithium use for more than 15 years, but off lithium for two years and not carrying the diagnosis of diabetes mellitus or nephrogenic diabetes insipidus (NDI), presented with coma and hyperglycemic hyperosmolar state (HHS). Following correction of HHS, he developed persistent hypernatremia accompanied by large volumes of urine with low osmolality and no response to desmopressin injections. Urine osmolality remained < 300 mOsm/kg after injection of vasopressin. Read More

    Disequilibrium syndrome and prevention in nonhemodialysis patients.
    Am J Med Sci 2015 May;349(5):438-41
    Departments of Internal Medicine (FKL, ARK), Pulmonary Medicine (Critical Care and Sleep) (YY), and Nephrology (DM, SV), University of Toledo Medical Center, Toledo, Ohio.
    Disequilibrium syndrome (DS) is a central nervous system disorder described in hemodialysis (HD) patients. The authors present 4 cases of elevated blood urea nitrogen (BUN); the first patient passed away from suspected DS, whereas the other 3 patients were identified as having a high risk of developing DS on the basis of their BUN. The authors tried to lower their BUN slowly and prevent rapid correction by different methods. Read More

    Hypertonic saline in paediatric traumatic brain injury: a review of nine years' experience with 23.4% hypertonic saline as standard hyperosmolar therapy.
    Anaesth Intensive Care 2015 Mar;43(2):204-10
    Department of Anaesthesia and Intensive Care, John Hunter Hospital, Newcastle, Australia.
    We describe the protocolised use of 23.4% hypertonic saline solution (HTS) for intracranial hypertension in the context of traumatic brain injury in the paediatric population. This study represents the largest published data on the use of 23. Read More

    Type 2 diabetes presenting with hyperglycaemic hyperosmolar state in an adolescent renal transplant patient.
    BMJ Case Rep 2015 Feb 20;2015. Epub 2015 Feb 20.
    Department of Diabetes & Endocrinology, Oxford Children's Hospital, Oxford, UK.
    Hyperglycaemic hyperosmolar state (HHS) is a life-threatening condition rarely seen in paediatrics. It is becoming increasingly recognised with the growing incidence of childhood type 2 diabetes mellitus (T2DM). We present a 16-year-old boy with Bardet-Biedl syndrome, with comorbidities including chronic renal impairment requiring renal transplant, isolated growth hormone (GH) deficiency and obesity, who presented on routine follow-up with new onset T2DM and in HHS. Read More

    Expedited diagnosis and management of inpatient hyperosmolar hyperglycemic nonketotic syndrome.
    J Am Assoc Nurse Pract 2015 Aug 30;27(8):426-32. Epub 2015 Jan 30.
    Department of Glycemic Control, St. Vicents Health System, Birmingham, Alabama.
    Purpose: This practice improvement project was formulated to determine accuracy rate in differentiating between two hyperglycemic crises (diabetes ketoacidosis [DKA] and hyperosmolar hyperglycemic nonketotic syndrome [HHNKS]) in a clinical population of individuals who manifested hyperglycemia and diabetes mellitus (DM). We hypothesized that HHNKS was commonly misdiagnosed as DKA. Our primary aim was to determine frequency of correct HHNKS diagnoses. Read More

    A successfully treated case of hypopituitarism complicated with hyperosmolar hyperglycaemic state and rhabdomyolysis.
    Scott Med J 2015 May 5;60(2):e7-e10. Epub 2015 Jan 5.
    Professor, The Second Part of First Hospital, Jilin University, China
    Introduction: This study aimed to report a rare case of hypopituitarism complicated with hyperosmolar hyperglycaemic state and rhabdomyolysis.

    Case Presentation: Hypopituitarism is a clinical syndrome in which there is a deficiency in hormone production by the pituitary gland. It often leads to hypoglycaemia, but in this case the patient was complicated with hyperosmolar hyperglycaemic state. Read More

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