Severe hypernatremia in soft drink ketoacidosis and hyperglycemic          hyperosmolar state at the onset of type 2 diabetes mellitus: a case series of three          adolescents

Choo, Soo Jeong; Lee, Hyun Gyung; Kim, Chan Jong; Yang, Eun Mi

doi:10.1297/cpe.2021-0075

“…Due to the change of dietary structure and the reduction of physical activity, obese children are gradually increasing, and the number of children and adolescents with type 2 diabetes is raising year after year [ 7 ], although type 1 diabetes is mostly in children. If effective methods are not used for timely treatment, acute complications such as impaired glucose tolerance and other chronic diseases are very likely to occur [ 8 , 9 ]. Children and adolescent patients with type 2 diabetes need special medical treatment and care, since they are different from adults in many aspects, such as changes in insulin sensitivity, growth and development, self-management ability, and susceptibility to hypoglycemia related to sexual maturity [ 10 – 12 ].…”

Section: Introductionmentioning

confidence: 99%

Meta-Analysis of the Effect of Nursing Intervention on Children with Type 2 Diabetes

Tang

¹

,

Xu

²

,

Yao

³

et al. 2022

Computational and Mathematical Methods in Medicine

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Objective. To systematically evaluate the effect of nursing intervention on children with type 2 diabetes. Methods. The randomized controlled trials (RCTs) on nursing intervention in children with type 2 diabetes in CNKI, VIP, WanFang, Chinese Biomedical Database (CBM), PubMed, The Cochrane Library, Embase, and Science were searched by the computer until July 2022. Two evaluators reviewed the articles, selected the information, and assessed their quality according to the inclusion criteria and exclusion criteria and then carried out meta-analysis with RevMan 5.3. Results. A total of 5 RCT studies were kept, including 319 patients with type 2 diabetes (≤21 years old), where 162 patients were in the nursing group and 157 patients were in the control group. Meta-analysis revealed that, compared with routine nursing, nursing intervention could effectively control children’s fasting blood glucose (FBG) ( MD = − 1.68 , 95% CI (-2.19, -1.17), P < 0.00001 ), 2 h postprandial blood glucose (2hPG) ( MD = − 4.01 , 95% CI (-4.70, -3.33), P < 0.00001 ), fasting insulin (FINS) ( MD = − 7.42 , 95% CI (-10.63, -4.20), P < 0.00001 ), 2 h postprandial insulin (2hINS) ( MD = − 58.18 , 95% CI (-103.24, -13.11), P = 0.01 ), triglycerides (TG) ( MD = − 0.41 , 95% CI (-0.56, -0.25), P < 0.00001 ), and systolic blood pressure (SBP) ( MD = − 8.85 , 95% CI (-14.67, -3.03), P = 0.003 ) and effectively maintain patients’ blood glucose at a normal level ( MD = − 8.85 , 95% CI (-14.67, -3.03), P = 0.003 ), where all the differences were statistically significant. Conclusion. The existing evidence showed that nursing intervention has a significant effect in controlling normal blood glucose and improving insulin utilization in children with type 2 diabetes, which can effectively improve the therapeutic effect on children.

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“…Also, the polydipsia described by the patient himself led to the unintentional ingestion of excessive amounts of sodium, primarily through his beverages of choice. Nevertheless, the patient’s hyperglycemia, hypernatremia, and free water deficit necessitated careful manipulation as a 2022 case series study describes the cases of DKA-HHS induced severe hypernatremia in three adolescents due to high soft drink consumption where one patient died due to development of severe hypovolemia[ 7 ]. As increased consumption of carbohydrate-rich beverages exacerbated glucose induced osmotic diuresis and resulted in worsening severe intravascular dehydration.…”

Section: Discussionmentioning

confidence: 99%

Severe hypernatremia in hyperglycemic conditions; managing it effectively: A case report

Lathiya¹,

Errabelli²,

Cullinan³

et al. 2023

World J Crit Care Med

3

0

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BACKGROUND Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are common acute complications of diabetes mellitus with a high risk of mortality. When combined with hypernatremia, the complications can be even worse. Hypernatremia is a rarely associated with DKA and HHS as both are usually accompanied by normal sodium or hyponatremia. As a result, a structured and systematic treatment approach is critical. We discuss the therapeutic approach and implications of this uncommon presentation. CASE SUMMARY A 62-year-old man with no known past medical history presented to emergency department with altered mental status. Initial work up in emergency room showed severe hyperglycemia with a glucose level of 1093 mg/dL and severe hypernatremia with a serum sodium level of 169 mEq/L. He was admitted to the intensive care unit (ICU) and was started on insulin drip as per DKA protocol. Within 12 h of ICU admission, blood sugar was 300 mg/dL. But his mental status didn’t show much improvement. He was dehydrated and had a corrected serum sodium level of > 190 mEq/L. As a result, dextrose 5% in water and ringer's lactate were started. He was also given free water via an nasogastric (NG) tube and IV Desmopressin to improve his free water deficit, which improved his serum sodium to 140 mEq/L. CONCLUSION The combination of DKA, HHS and hypernatremia is rare and extremely challenging to manage, but the most challenging part of this condition is selecting the correct type of fluids to treat these conditions. Our case illustrates that desmopressin and free water administration via the NG route can be helpful in this situation.

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“…In this section, the reported age of the patients at the hyperglycemic episode ranged between 5 days [59] and 87 years [117]. Infants, children, and adolescents up to 18 years of age accounted for 44 case reports [59,64,65,67,69,75,86,[97][98][99][100][101]103,106,108,118,120,121]. The gender of patients, 68 females and 82 males, was provided in 150 case reports.…”

Section: Case Reports Of Hypernatremia In Hyperglycemic Syndromesmentioning

confidence: 99%

“…Many patients, particularly infants and children, had no previous history of diabetes. Most of the patients had HHS, but several patients, particularly infants or children, had DKA-HHS [27,40,47,49,51,59,64,67,93,99,101,103,106,108,112,115,117,118,120,121].…”

Section: Case Reports Of Hypernatremia In Hyperglycemic Syndromesmentioning

confidence: 99%

“…Other reported conditions precipitating episodes of DKA or HHS with hypernatremia included pancreatitis [27,52,61,83], corticosteroid excess, either after administration as treatment [57,70,112], or in Cushing's syndrome [109], heat stroke [65], diarrhea in infants [65,69], pancreatic carcinoma [56,80], discontinuation of diabetic medications [58,70,102], intravenous hyperalimentation [73], excessive intake of food items containing glucose and electrolytes [64,100,101,106,117,118,121], and extensive burns [38,42,55,66,86]. The two last conditions merit comment.…”

Section: Case Reports Of Hypernatremia In Hyperglycemic Syndromesmentioning

confidence: 99%

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Hypernatremia in Hyperglycemia: Clinical Features and Relationship to Fractional Changes in Body Water and Monovalent Cations during Its Development

Wagner,

Ing,

Roumelioti

et al. 2024

JCM

2

0

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In hyperglycemia, the serum sodium concentration ([Na]S) receives influences from (a) the fluid exit from the intracellular compartment and thirst, which cause [Na]S decreases; (b) osmotic diuresis with sums of the urinary sodium plus potassium concentration lower than the baseline euglycemic [Na]S, which results in a [Na]S increase; and (c), in some cases, gains or losses of fluid, sodium, and potassium through the gastrointestinal tract, the respiratory tract, and the skin. Hyperglycemic patients with hypernatremia have large deficits of body water and usually hypovolemia and develop severe clinical manifestations and significant mortality. To assist with the correction of both the severe dehydration and the hypovolemia, we developed formulas computing the fractional losses of the body water and monovalent cations in hyperglycemia. The formulas estimate varying losses between patients with the same serum glucose concentration ([Glu]S) and [Na]S but with different sums of monovalent cation concentrations in the lost fluids. Among subjects with the same [Glu]S and [Na]S, those with higher monovalent cation concentrations in the fluids lost have higher fractional losses of body water. The sum of the monovalent cation concentrations in the lost fluids should be considered when computing the volume and composition of the fluid replacement for hyperglycemic syndromes.

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Severe hypernatremia in soft drink ketoacidosis and hyperglycemic hyperosmolar state at the onset of type 2 diabetes mellitus: a case series of three adolescents

Abstract: Hypernatremia in mixed DKA and HHS Choo et al.

Cited by 6 publications

References 18 publications

Meta-Analysis of the Effect of Nursing Intervention on Children with Type 2 Diabetes

Meta-Analysis of the Effect of Nursing Intervention on Children with Type 2 Diabetes

Severe hypernatremia in hyperglycemic conditions; managing it effectively: A case report

Hypernatremia in Hyperglycemia: Clinical Features and Relationship to Fractional Changes in Body Water and Monovalent Cations during Its Development

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