Hyperglycemic Crises in Patients With Diabetes Mellitus

Association, American Diabetes

doi:10.2337/diacare.24.1.154

Cited by 227 publications

(12 citation statements)

References 32 publications

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“…HHS was defined by the presence of severe hyperglycemia (glucose>600mg/dL), and hyperosmolarity >320 mOsmol/L with little or no ketonemia/ketonuria 17…”

Section: Methodsmentioning

confidence: 99%

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Clinical profile and outcomes of adult patients with hyperglycemic emergencies managed at a tertiary care hospital in Nigeria

Edo

2012

Niger Med J

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Background:To document the clinical profile and treatment outcomes of diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) managed in a tertiary care hospital.Materials and Methods:This was a retrospective review of hospital records of patients with DKA and HHS admitted to a tertiary care hospital over a 24-month period. Data on demographics, precipitating factors, clinical features, serum electrolytes, duration of hospital admission, and mortality were extracted.Results:Eighty-four patients were included in the study. Fifty (59.5%) were females. Ten (11.9%) persons had type 1 diabetes mellitus (T1DM) and 74 (88.1%) had type 2 diabetes mellitus (T2DM). There were 35 cases of DKA and 49 cases of HHS. Nine patients with T1DM presented in DKA and one in HHS. Forty-eight (55.2%) subjects were previously not diagnosed of diabetes mellitus (DM). The mean±SEM age, casual blood glucose, calculated serum osmolality, and duration of hospital stay of the study subjects were 50.59±1.63 years, 517.98±11.69 mg/dL, 313.59±1.62 mOsmol/L, and 18.85±1.78 days, respectively. Patients with T2DM were significantly older than those with T1DM (54.32±1.34 vs. 23.40±1.38 years, P<0.001).The precipitating factors were poor drug compliance 23 (27.4%), malaria 12 (14.3), urinary tract infection 10 (11.9%), lobar pneumonia 4 (4.8%), and unidentifiable in 29 (34.5%). Common electrolyte derangements were hyponatremia, 31 (36.9%) and hypokalemia 21 (25%). Mortality rate was 3.6%.Conclusion:DKA is common in patients with T2DM.Over 50% of the patients presenting with DKA or HHS have no previous diagnosis of DM. Non-compliance, malaria, and infections are important precipitants. Mortality rate is low.

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“…HHS was defined by the presence of severe hyperglycemia (glucose>600mg/dL), and hyperosmolarity >320 mOsmol/L with little or no ketonemia/ketonuria 17…”

Section: Methodsmentioning

confidence: 99%

“…Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are acute complications of diabetes mellitus (DM) that are potentially life threatening if left untreated 1. DKA is common in type 1 diabetes mellitus (T1DM) while HHS is common in type 2 diabetes mellitus (T2DM).…”

Section: Introductionmentioning

confidence: 99%

Clinical profile and outcomes of adult patients with hyperglycemic emergencies managed at a tertiary care hospital in Nigeria

Edo

2012

Niger Med J

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“…The process of HHS usually evolves over several days to weeks, whereas the evolution of the acute DKA episode in type 1 diabetes or even in type 2 diabetes tends to be much shorter. Although the symptoms of poorly controlled diabetes may be present for several days, the metabolic alterations typical of ketoacidosis usually evolve within a short time frame (typically <24 h) [ 35 ].…”

Section: Introductionmentioning

confidence: 99%

“…Physical findings may include poor skin turgor, Kussmaul’s respiration, tachycardia, hypotension, alteration in mental status, shock, fever or hypothermia and ultimately coma. Mental status can vary from full alertness to profound lethargy or coma, with the latter more frequent in HHS [ 35 ].…”

Section: Introductionmentioning

confidence: 99%

Serum C-peptide assay of patients with hyperglycemic emergencies at the Lagos State University Teaching Hospital (LASUTH), Ikeja

Akinlade¹,

Ogbera²,

Fasanmade³

et al. 2014

Int Arch Med

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IntroductionHE are common acute complications of diabetes mellitus (DM) and include diabetic ketoacidosis (DKA), normo-osmolar hyperglycemic state (NHS) and hyperosmolar hyperglycemic state (HHS). They contribute a lot to the mortality and morbidity of DM. The clinical features include dehydration, hyperglycemia, altered mental status and ketosis. The basic mechanism of HE is a reduction in the net effective action of circulating insulin, resulting in hyperglycemia and ketonemia (in DKA) causing osmotic diuresis and electrolytes loss. Infection is a common precipitating factor.Measurement of serum C-peptide provides an accurate assessment of residual β-cell function and is a marker of insulin secretion in DM patients.Aim and objectivesTo assess the level of pancreatic beta cell function in HE patients, using the serum C-peptide.MethodologyThe biodata and clinical characteristics of the 99 subjects were collated using a questionnaire. All subjects had their serum C-peptide, glucose, electrolytes, urea, creatinine levels, urine ketones determined at admission. Results of statistical analysis were expressed as mean ± standard deviation (SD). A p value <0.05 was regarded statistically significant. Correlation between levels of serum C-peptide and admission blood glucose levels and the duration of DM respectively was done.ResultsThe mean age of the subjects was 51 (SD ± 16) years and comparable in both sexes. Mean duration of DM was 6.3 (SD ± 7.1) years, with 35% newly diagnosed at admission.The types of HE in this study are: DKA (24.7%), NHS (36.1%), and HHS (39.2%). Mean blood glucose in this study was 685 mg/dL, significantly highest in HHS and lowest in NHS. Mean serum C-peptide level was 1.6 ng/dL. It was 0.9 ng/dL in subjects with DKA and NHS while 2.7 ng/dL in HHS (p>0.05).Main precipitating factors were poor drug compliance, new-onset of DM and infection.ConclusionMost (70%) of subjects had poor pancreatic beta cell function, this may be a contributory factor to developing HE. Most subjects with high C-peptide levels had HHS.Electronic supplementary materialThe online version of this article (doi:10.1186/1755-7682-7-50) contains supplementary material, which is available to authorized users.

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“…A bolus dose of 0.15 units/ kg may be given while monitoring the blood glucose level every hour. [17] If the levels do not fall by approximately 75 mg/ dl/h, the infusion rate of insulin is doubled. Once the levels fall to 230-300 mg/dl, 5% dextrose infusion is started.…”

Section: Emergency Presentation Of Diabetes Mellitusmentioning

confidence: 99%

Endocrine emergencies in critically ill patients: Challenges in diagnosis and management

Bajwa

Jindal

2012

Indian J Endocr Metab

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Endocrine emergencies pose unique challenges for the attending intensivist while managing critically ill patients. Besides taking care of primary disease state, one has to divert an equal attention to the possible associated endocrinopathies also. One of the common reasons for inability to timely diagnose an endocrinal failure in critically ill patients being the dominance of other severe systemic diseases and their clinical presentation. The timely diagnosis and administration of therapeutic interventions for these endocrine disorders can improve the outcome in critically ill patients. The timely diagnosis and administration of timely therapeutics in common endocrine disorders like severe thyroid disease, acute adrenal insufficiency and diabetic ketoacidosis significantly influence the outcome and prognosis. Careful evaluation of clinical history and a high degree of suspicion are the corner stone to diagnose such problems. Aggressive management of the patient is equally important as the complications are devastating and can prove highly fatal. The present article is an attempt to review some of the common endocrine emergencies in intensive care unit and the challenges associated with their diagnosis and management.

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Hyperglycemic Crises in Patients With Diabetes Mellitus

Cited by 227 publications

References 32 publications

Clinical profile and outcomes of adult patients with hyperglycemic emergencies managed at a tertiary care hospital in Nigeria

Clinical profile and outcomes of adult patients with hyperglycemic emergencies managed at a tertiary care hospital in Nigeria

Serum C-peptide assay of patients with hyperglycemic emergencies at the Lagos State University Teaching Hospital (LASUTH), Ikeja

Endocrine emergencies in critically ill patients: Challenges in diagnosis and management

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