Background:Diabetes mellitus (DM) is a chronic medical disorder characterized by hyperglycemia. It arises due to inability of pancreas to produce insulin, either because of impaired insulin secretion, impaired action or both. Most of the untreated or inadequately treated patients develop acute metabolic complications. These complications are associated with high mortality and morbidity. Most common among the acute metabolic complications are diabetic ketoacidosis (DKA), hyperglycemic, hyperosmolar, non-ketotic state (HHNKS), Lactic acidosis (LA) and hypoglycemia. Early diagnosis and management of DM helps in preventing these complications. This study was aimed to determine the incidence of acute metabolic complications in DM and to determine the distribution of age and sex in different metabolic complications of diabetes mellitus.Methods: A prospective study was conducted on all cases presenting to Emergency Medicine department for a period of one year from April 2014 to March 2015.Results:Out of the 1211 cases 632 were Diabetic ketoacidosis, 329 cases were hypoglycemia, 201 cases were hyperglycemic hyperosmolar nonketotic state, 12 cases were lactic acidosis. The other 37 cases had findings which were overlapping with more than one type of acute metabolic complications related to diabetes mellitus. Two cases of HHNKS were associated with attacks of hypoglycemia. In this study, diabetic ketoacidosis was the common acute metabolic complication affecting Males aged less than 15 years.Conclusions:Hypoglycemia is the commonest iatrogenic acute metabolic complications India diabetes mellitus. HHNKS affects patients aged more than 45 years. In some cases, there is considerable overlap of diabetic ketoacidosis, lactic acidosis, hypoglycemia and HHNKS.

Objective: To evaluate Hem-o-Lok polymer clips’ feasibility, safety and cost-effectiveness in controlling the splenic pedicle during paediatric laparoscopic splenectomy.Method: The prospective study was conducted from May 2019 to December 2021 at Kafrelsheikh University Hospital, Egypt, and comprised children of either gender aged <18 years who had benign haematological diseases and were indicated for laparoscopic splenectomy. During the procedure, Hem-o-Lok clips were used for controlling the splenic pedicle. Patients were encouraged to ambulate the same day, and the drain was removed 24hours postoperatively. The cases were followed up for three months postoperatively.Results: Of the 23 subjects, 11(47.8%) were boys and 12(52.2%) were girls. The overall mean age was 8.74±3.44 years (range: 4-15 years). There were 6(26%) cases of spherocytosis, 1(4.3%) immune thrombocytopenic purpura and 16(69.6%) with thalassemia major. The mean operative time was 93.43±29.87 minutes (range: 65-180 minutes). There was no conversion to open splenectomy and no mortality. There were 2(8.7%) cases of minor and 1(4.3%) of major intraoperative bleeding. All the 3(100%) cases were controlled laparoscopically. No postoperative bleeding occurred and no cases required postoperative blood transfusion.Conclusion: Controlling both the splenic artery and vein using Hem-o-Lok clips was found to be feasible, safe and cost-effective.Keywords: Purpura, Thrombocytopenic, Idiopathic, Spleen, Splenic artery, Thalassemia, Laparoscopy, Polymers.