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Hyperglycemic Crises: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State

Coronavirus Guidelines. Visit free Relief Central. Prime PubMed is provided free to individuals by: Unbound Medicine. Hyperglycemic hyperosmolar state. Diabetic ketoacidosis DKA , hyperglycemic hyperosmolar state HHS , lactic acidosis LA , and hypoglycemia are acute and potentially life-threatening complications of diabetes. DKA and severe hypoglycemia are more common in type 1 diabetes, while HHS without ketoacidosis is associated more frequently with type 2 diabetes.

The frequency of DKA among adult patients at diagnosis is unknown. A small group of high-risk patients accounts for most recurring DKA in longstanding type 1 diabetes, but the incidence remains high—approximately 1—12 episodes per patient-years.

In —, LA accounted for 1. Also in —, hypoglycemia was listed as an underlying cause in nearly , hospitalizations, which represented 5. Severe hypoglycemia, i. All four acute complications are theoretically preventable; unfortunately, they still account for enormous morbidity, hospitalizations, and mortality among diabetic patients and contribute significantly to the high costs of diabetes care.

In this brief review, we have attempted to categorise and classify such heterogenous hyperglycemic states. Patients not inflicted with COVID infection and diagnosed with either type 2 diabetes mellitus T2DM or type 1 diabetes mellitus T1DM show more severe hyperglycemia and more ketoacidosis, respectively. In former, it could be attributed to weight gain, decreased exercise, stress and in both type of diabetes, due to delayed diagnosis during lockdown and pandemic.

In patients with COVID and associated pneumonia, altered glucose metabolism leading to hyperglycemia could be due to corticosteroids, cytokine storm, damage to pancreatic beta cells, or combination of these factors. Some of these patients present with diabetic ketoacidosis, hyperglycemic hyperosmolar state or both. Distigmine bromide is widely used to treat neurogenic bladder and causes cholinergic crisis, a serious side effect.

We herein report about a patient with distigmine bromide-induced cholinergic crisis complicated by a hyperosmolar hyperglycemic state HHS. On admission, the patient was diagnosed with HHS based on the medical history and laboratory test results. However, she also had bradycardia, miosis, and low plasma cholinesterase activity. We later found that she had received distigmine bromide, which led to a diagnosis of cholinergic crisis. We suggest that the exacerbation of pathology, including HHS, can cause cholinergic crisis in patients receiving distigmine bromide.

Comparative study of emphysematous pyelonephritis and pyelonephritis in type 2 diabetes: a single-centre experience. Hyperglycaemic hyperosmolar state: first presentation of type 1 diabetes mellitus in an adolescent with complex medical needs.

This is a case of hyperglycaemic hyperosmolar state HHS as first presentation of type 1 diabetes mellitus in a year-old girl with background complex medical needs. Paediatric patients with HHS will likely be treated with the diabetes ketoacidosis DKA protocol because of perceived rarity of HHS leading to inadequate rehydration and risk of vascular collapse. Prompt recognition and adequate management are crucial to avert complications.

The undesirable rate of decline of hypernatraemia due to the use of hypotonic fluid was captured in this case. We describe the pivotal role of liberal fluid therapy with non-hypotonic fluids. COVID and emergencies in patients with diabetes: two case reports. Recurrent hyperglycemic hyperosmolar state after re-administration of dose-reduced ceritinib, an anaplastic lymphoma kinase inhibitor.

Hyperglycemia is a known adverse event, but the mechanism by which ceritinib causes hyperglycemia is unknown, and whether ceritinib causes hyperglycemic emergencies is unclear. Here, we report the case of a patient with a hyperglycemic hyperosmolar state HHS recurrence after the re-administration of dose-reduced ceritinib. After 28 days of ceritinib administration, he was admitted to our hospital due to HHS.

His blood glucose level improved with insulin therapy after discontinuation of the ceritinib. He then received re-administration with a decreased ceritinib dose while maintaining the insulin treatment to control his blood glucose, but his HHS recurred.

We discontinued the ceritinib for other side effects and noticed the HHS disappeared. Extreme Hyperglycemia in an Elderly Patient. Clinical profiles, outcomes and risk factors among type 2 diabetic inpatients with diabetic ketoacidosis and hyperglycemic hyperosmolar state: a hospital-based analysis over a 6-year period.

Ocular flutter and myoclonus in hyperosmolar hyperglycemic state. Mesenteric venous thrombosis: A lethal complication of hyperglycemic crises. In hyperglycemia, hypertonicity results from solute glucose gain and loss of water in excess of sodium plus potassium through osmotic diuresis.

Patients with stage 5 chronic kidney disease CKD and hyperglycemia have minimal or no osmotic diuresis; patients with preserved renal function and diabetic ketoacidosis DKA or hyperosmolar hyperglycemic state HHS have often large osmotic diuresis. Hypertonicity from glucose gain is reversed with normalization of serum glucose [Glu] ; hypertonicity due to osmotic diuresis requires infusion of hypotonic solutions.

Prediction of the serum sodium after [Glu] normalization the corrected [Na] estimates the part of hypertonicity caused by osmotic diuresis. Theoretical methods calculating the corrected [Na] and clinical reports allowing its calculation were reviewed.

The theoretical prediction of [Na] increase by 1. Mean corrected [Na] was In patients with preserved renal function, mean corrected [Na] was within the eunatremic range However, in DKA corrected [Na] was in the hypernatremic range in several reports and rose during treatment with adverse neurological consequences in other reports.

The corrected [Na], computed as [Na] increase by 1. However, the corrected [Na] may change during treatment because of ongoing fluid losses and should be monitored during treatment. 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.

Symptoms slowly resolved over the course of two weeks by administration of insulin and normalizing the glucose. Predictions of diabetes complications and mortality using hba1c variability: a year observational cohort study. Intravenous IV infusion of insulin remains the treatment of choice for treating DKA; however, the policy of many hospitals around the world requires admission to an intensive care unit ICU for IV insulin infusion.

During the coronavirus COVID pandemic or other settings where intensive care resources are limited, ICU services may need to be prioritized or may not be appropriate due to risk of transmission of infection to young people with type 1 or type 2 diabetes. The aim of this guideline, which should be used in conjunction with the ISPAD guidelines, is to ensure that young individuals with DKA receive management according to best evidence in the context of limited ICU resources.

Specifically, this guideline summarizes evidence for the role of subcutaneous insulin in treatment of uncomplicated mild to moderate DKA in young people and may be implemented if administration of IV insulin is not an option. Case 1 was a year-old boy, presenting with typical laboratory test values and symptoms consistent with DKA and HHS.

This patient developed right lung artery thrombosis, which did not require treatment. The hyperglycemic hyperosmolar state HHS is a serious acute complication of type 2 diabetes mellitus that requires prompt recognition, diagnosis, and treatment. Reversible acute kidney injury is common in hyperglycemic states. However, hyperglycemic emergencies can contribute to the development of rhabdomyolysis, which can further aggravate acute kidney injury and can cause high morbidity and mortality.

HHS can be the first clinical presentation of diabetes mellitus in some patients. Here, we present a case of HHS-related rhabdomyolysis and acute kidney injury, which was the first presentation of type 2 diabetes mellitus in this patient.

Our case highlights the importance of a rare association between rhabdomyolysis and HHS in diabetic patients. Teaching NeuroImages: Nonketotic hyperglycemic hyperosmolar state mimicking acute ischemic stroke. Hospital Diabetes Meeting Patients with diabetes may experience adverse outcomes related to their glycemic control when hospitalized.

Continuous glucose monitoring systems, insulin-dosing software, enhancements to the electronic health record, and other medical technologies are now available to improve hospital care. Because of these developments, new approaches are needed to incorporate evolving treatments into routine care.

With the goal of educating healthcare professionals on the most recent practices and research for managing diabetes in the hospital, Diabetes Technology Society hosted the Virtual Hospital Diabetes Meeting on April , Because of the coronavirus disease COVID pandemic, the meeting was restructured to be held virtually during the national lockdown to ensure the safety of the participants and allow them to remain at their posts treating COVID patients.

The meeting focused on 1 inpatient management and perioperative care, 2 diabetic ketoacidosis and hyperglycemic hyperosmolar state, 3 computer-guided insulin dosing, 4 Coronavirus Disease and diabetes, 5 technology, 6 hypoglycemia, 7 data and cybersecurity, 8 special situations, 9 glucometrics and insulinometrics, and 10 quality and safety. This meeting report contains summaries of each of the ten sessions. A virtual poster session will be presented within two months of the meeting.

Diabetes mellitus DM is one of the risk factors associated with severe illness in COVID leading to increased hospital admissions and mortality. Case report]. Clinical characteristics and outcome in patients with combined diabetic ketoacidosis and hyperosmolar hyperglycemic state associated with COVID A retrospective, hospital-based observational case series.

Hyperglycemic hyperosmolar state in a chimpanzee Pan troglodytes. A year-old female chimpanzee Pan troglodytes presented for cachexia, acute weakness, hyporexia, icterus, and polyuria. The animal was diagnosed with a hyperglycemic hyperosmolar state, which is a well-recognized syndrome in diabetic humans that is rarely diagnosed in animals.

This case documents an important and likely under-reported syndrome in non-human primates. Multicentre analysis of hyperglycaemic hyperosmolar state and diabetic ketoacidosis in type 1 and type 2 diabetes. 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. HCHB is a movement disorder primarily associated with cerebrovascular accidents of infarct or hemorrhagic origin.

It is a condition that can occur in a diabetic patient, especially when no other signs or symptoms of hyperglycemia are present. It is urgent to recognize HCHB movement disorder quickly as it may be the only presenting sign of hyperglycemia and can alert medical personnel to a possible hyperosmolar hyperglycemic state HHS.

We report an unusual case of HCHB in a patient with HHS, whose only presenting sign was unilateral hyperkinesis, which completely resolved after adequate blood glucose control.

Prompt treatment and management of hyperglycemia yields an excellent prognosis in HCHB.

Diabetic ketoacidosis and hyperglycemic hyperosmolar state

In this review, the authors discuss the similarities and differences between diabetic ketoacidosis and the hyperosmolar hyperglycemic state, providing clinical pearls and common pitfalls to help guide the clinician in the diagnosis and management. Diabetic ketoacidosis DKA and hyperosmolar hyperglycemic state HHS are similar but distinct diabetic emergencies that are frequently encountered in the ED. In both syndromes, there is insufficient insulin levels to transport glucose into cells. As previously noted, although DKA and HHS share similar characteristic signs and symptoms, they are two distinct conditions that must be differentiated in the clinical work-up. One characteristic that helps the emergency physician EP to distinguish between the two conditions is the patient age at symptom onset.

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If your institution subscribes to this resource, and you don't have a MyAccess Profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus. Please consult the latest official manual style if you have any questions regarding the format accuracy. Diabetic ketoacidosis DKA , hyperglycemic hyperosmolar nonketotic coma HHNC , and hypoglycemia are life-threatening disorders of glucose metabolism. Altered glucose metabolism should be considered in the differential diagnosis of all patients with mental status changes, neurologic deficits, and severe illness. Mixed-anion-gap acidosis and hyperosmolarity are encountered often in the same patient. Continuous insulin therapy is essential in DKA.

Diabetic ketoacidosis

Diabetic ketoacidosis DKA is a potentially life-threatening complication of diabetes mellitus. DKA happens most often in those with type 1 diabetes but can also occur in those with other types of diabetes under certain circumstances. The primary treatment of DKA is with intravenous fluids and insulin.

Diabetic ketoacidosis DKA and hyperglycemic hyperosmolar state HHS are the two most serious hyperglycemic emergencies in patients with diabetes mellitus. DKA most often occurs in patients with type 1 diabetes, but patients with type 2 diabetes are susceptible to DKA under stressful conditions such as trauma, surgery, or infections. HHS is more common in adult and elderly patients with poorly controlled type 2 diabetes.

Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic Syndrome Management

There is a maddening degree of variation between different definitions for HHS. This is a mistake. There are enormous physiological differences between these conditions that mandate different management. Lumping both conditions together into a single treatment algorithm will cause HHS to be treated overly aggressively.

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If your institution subscribes to this resource, and you don't have a MyAccess Profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus. Please consult the latest official manual style if you have any questions regarding the format accuracy. Diabetic ketoacidosis DKA , hyperglycemic hyperosmolar nonketotic coma HHNC , and hypoglycemia are life-threatening disorders of glucose metabolism. Altered glucose metabolism should be considered in the differential diagnosis of all patients with mental status changes, neurologic deficits, and severe illness. Mixed-anion-gap acidosis and hyperosmolarity are encountered often in the same patient. Continuous insulin therapy is essential in DKA.

Diabetic ketoacidosis DKA and hyperglycemic hyperosmolar state HHS are the two most serious hyperglycemic emergencies in patients with diabetes mellitus. DKA most often occurs in patients with type 1 diabetes, but patients with type 2 diabetes are susceptible to DKA under stressful conditions such as trauma, surgery or infections. HHS is more common in adult and elderly patients with poorly controlled type 2 diabetes. In the U. DKA and HHS are characterized by insulinopenia and severe hyperglycemia; clinically, these two conditions differ by severity of metabolic acidosis, dehydration, metabolic acidosis and ketonemia. Management objectives for DKA and HHS include restoration of circulatory volume and tissue perfusion; correction of hyperglycemia, ketogenesis and electrolyte imbalance; and identification and treatment of the precipitating event. This review describes the clinical presentation, precipitating causes, diagnosis and acute management of these diabetic emergencies, and of practical strategies for their prevention.

Skip to search form Skip to main content You are currently offline. Some features of the site may not work correctly. Corpus ID: Diagnosis and treatment of diabetic ketoacidosis and the hyperglycemic hyperosmolar state. Aris-Jilwan and R. Bertrand and H. Beauregard and J. Diabetic ketoacidosis and the hyperglycemic hyperosmolar state are the most serious complications of diabetic decompensation and remain associated with excess mortality.

Hyperosmolar hyperglycemic state (HHS)

Diabetic ketoacidosis DKA is a life-threatening emergency caused by a relative or absolute deficiency of insulin. This deficiency in available insulin results in disorders in the metabolism of carbohydrate, fat, and protein. Main clinical features of DKA are hyperglycemia , acidosis, dehydration , and electrolyte losses such as hypokalemia, hyponatremia, hypocalcemia, hypomagnesemia, and hypophosphatemia. There is enough production of insulin to reduce ketosis but not to control hyperglycemia.

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Hyperglycemic Crises: Diabetic Ketoacidosis (DKA), And Hyperglycemic Hyperosmolar State (HHS)

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Diagnosis and treatment of diabetic ketoacidosis and the hyperglycemic hyperosmolar state.

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Magdiotima 04.05.2021 at 18:18

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Article · Figures & Tables · Info & Metrics · PDF. Loading. Abstract. In Brief. Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS) are.

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