Ketoacidosis and Hyperosmolarity as First Symptoms of Type 1 Diabetes Mellitus Following Ingestion of High-Carbohydrate- Containing Fluids

Vanelli, Maurizio; Chiari, G; Ghizzoni, Lucia; Capuano, C.; Bonetti, Luca Reggiani; Costi, G.; Giacalone, T; Chiarelli, Francesco

doi:10.1515/jpem.1999.12.5.691

Cited by 5 publications

(6 citation statements)

References 1 publication

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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%

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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“…Previous reports have described similar scenarios associated with T1DM in adolescents who had free access to high-carbohydrate-containing fluids. 3,4 Interestingly, our third case involved a 15-month-old male who relied solely on his family for fluid replacement. Our experience demonstrates that even toddlers with new onset T1DM, who ingest sugar-and salt-containing fluids, are also at risk for developing the same degree of hyperosmolarity as seen in older children and adolescents.…”

Section: Discussionmentioning

confidence: 98%

“…2 Some reports have implicated high-carbohydrate-containing beverages in causing exaggerated hyperglycemia and hyperosmolarity, resembling the clinical and laboratory picture of HHS, in the acute presentation of type 1 diabetes mellitus (T1DM). 3,4 With the high case fatality rates associated with HHS, patients with diabetes presenting in a similar manner require prompt identification to ensure adequate fluid replacement and gradual correction of serum osmolarity. 5 The following cases describe 3 children seen at our institution with new onset T1DM and severe hyperglycemia, hypernatremia, and hyperosmolarity.…”

Section: Introductionmentioning

confidence: 99%

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

Viswanathan

Beardsley

Walvoord

et al. 2010

Clin Pediatr (Phila)

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“…The high intake of carbohydrate-laden fluids may thus accelerate symptoms in such cases. Only one previously reported case has documented the occurrence of HHS in T1DM precipitated by carbonated soft drinks (9).…”

Section: Discussionmentioning

confidence: 99%

Diabetic ketoacidosis, hyperosmolarity and hypernatremia: are high-carbohydrate drinks worsening initial presentation?

et al. 2005

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The case of five pediatric patients who presented to the Royal Children's Hospital, Melbourne with newly diagnosed diabetes mellitus between January 2001 and September 2003 is reported. Each case was complicated by hyperosmolarity and hypernatremia and required intensive therapy. Fluid intake prior to admission in each case was documented and consisted of between 5 and 12 L of carbonated carbohydrate beverages and 'isotonic' sports drinks. At presentation, biochemical results of the four cases (four males and one female), mean age 13.6 yr (range 11.7-15.1 yr) included glucose (mean 1460 mg/dL; range 864-2106), adjusted sodium (mean 176.3 mmol/L; range 165-183), serum osmolarity (mean 399 mmol/kg; range 364-424), anion gap (mean 48 mEq/L; range 42-84), and pH (mean 7.15; range 7.01-7.27). All five cases had evidence of ketonuria on presentation. Treatment in all five cases consisted of replacement of fluids over a prolonged period of 72 h and careful monitoring of electrolyte response. Three of five cases required hemofiltration in the first 48 h postadmission. All five cases made a complete recovery without neurological sequelae. Carbonated carbohydrate fluid intake may precipitate a more severe presentation of type 1 diabetes mellitus (T1DM). Fluid composition and intake should be carefully estimated at admission to help identify and manage similar cases.

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Ketoacidosis and Hyperosmolarity as First Symptoms of Type 1 Diabetes Mellitus Following Ingestion of High-Carbohydrate- Containing Fluids

Cited by 5 publications

References 1 publication

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

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

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

Diabetic ketoacidosis, hyperosmolarity and hypernatremia: are high-carbohydrate drinks worsening initial presentation?

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