Extreme Hyperglycemia and Hyperosmolar State in New Onset Type 1 Diabetes: Are Sugar- and Salt-Containing Beverages at Fault?

Viswanathan, Vidhya; Beardsley, Andrew L.; Walvoord, Emily C.; Nebesio, Todd D.

doi:10.1177/0009922810379502

Cited by 4 publications

(1 citation statement)

References 9 publications

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“…These drinks contain an average of 40 g of sugar and 15-120 mg of sodium per 370 mL [8]. Similar cases were also reported by Vanelli and Viswanathan et al [9,10]. In addition to frequent soft drink ingestion, our patient was insulin non-compliant.…”

Section: Discussionsupporting

confidence: 86%

Life-Threatening Hypernatremia in a 22-Year-Old Man With Concurrent Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State

Phan¹,

Phan²,

Truong³

et al. 2020

IJCR

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In diabetic ketoacidosis (DKA), hyponatremia is commonly observed due to hyperglycemia-induced water shift and osmotic diuresis. Thus, hypernatremia is rare and indicative of severe free water loss. We describe here a case of DKA with life-threatening hypernatremia. A 22-year-old type 1 diabetic male was admitted after experiencing polyuria and polydipsia, followed by nausea, vomiting, and lethargy for 2 weeks. On admission, plasma glucose was 1230 mg/dL and plasma sodium was 158 mEq/L. The patient developed acute kidney injury, lactic acidosis, and ketosis. Despite fluid resuscitation, sodium level continued to rise to 180 mEq/L. Tachycardia persisted and shock liver developed. After free water-deficit calculation, the patient was given more boluses of isotonic fluid in addition to 0.45% NaCl. Tachycardia began to improve, and hypernatremia and hyperglycemia were safely reduced. This case demonstrated how tedious volume evaluation and resuscitation helped the patient fully recover despite extreme hypernatremia, lethargy, and multiorgan failure.

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Section: Discussionsupporting

confidence: 86%