The Syndrome of Dehydration, Coma and Severe Hyperglycemia without Ketosis in Patients Convalescing from Burns

Rosenberg, Steven A.; Brief, Donald K.; Kinney, John M.; Herrera, María Teresa; Wilson, Richard E.; Moore, Francis D.

doi:10.1056/nejm196505062721802

Cited by 51 publications

(7 citation statements)

References 33 publications

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“…Sung et al [81] confirmed an increased infection rate, length of stay and mortality at a BG threshold of 200 mg/dl. Burn victims frequently experience a systemic inflammatory, hepatic acute-phase response, protein catabolism, insulin resistance and hyperglycemia [80,[82][83][84][85], and, if untreated, they sometimes are at risk for metabolic emergency [86]. Milder abnormalities of glucose metabolism are common in both adults and children suffering burns [87].…”

Section: Burn and Trauma Patientsmentioning

confidence: 99%

Practical aspects of intensive insulinization in the intensive care unit

Boulkina

Braithwaite

2007

Current Opinion in Clinical Nutrition and Metabolic Care

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Attainment and preservation of glycemic control among critically ill patients are best attempted with intravenous insulin infusion. Advances in the design of decision support and insulin delivery systems, and progress in the technology of continuous blood glucose monitoring, are likely to reduce the risk of hypoglycemia, without compromise of target range control, such that the patient outcomes enjoyed by experienced centers in the future will prove generalizable to others through the extension of new technologies.

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Section: Burn and Trauma Patientsmentioning

confidence: 99%

Practical aspects of intensive insulinization in the intensive care unit

Boulkina

Braithwaite

2007

Current Opinion in Clinical Nutrition and Metabolic Care

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“…A new type of hyperosmolar hyperglycemic non‐ketotic coma has been described, namely, that precipitated by a high concentration of carbohydrates in the diet of patients convalescing from severe burns (12). Peritoneal dialysis with large amounts of hypertonic glucose solution may also result in serum hyperosmolality.…”

Section: Hyperosmolar Nonketotic Diabetic Comamentioning

confidence: 99%

Hyperosmolar States in the Chronically Ill

Berenyi

Straus

1969

J American Geriatrics Society

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Three chronically ill patients with hyperosmolar states of different origin were studied. The discussion involves hyperglycemic nonketotic coma, coma due to tube feeding of high‐protein nutrients, and hyperosmolality following diuretic administration and an inadequate intake of fluids. The hypertonic dehydration of these patients was caused by a deficit of water and an excess of solutes. Common to all 3 cases were urinary‐tract infections with probable pyelonephritis. The loss of concentrating power in the pyelonephritic kidney results in a reduction of the ability to conserve body water. In older patients, there is an increase in the obligatory water loss via the urine because tubular function in the aging arteriosclerotic kidney is diminished. Other important factors in the pathogenesis of hyperosmolar states are fever, infection, inability to respond to thirst, impairment of glucose tolerance, and the frequent use of diuretics. The essential elements of management are early recognition and prompt correction with hypotonic solutions.

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“…[1][2][3][4][5][6][7] Sleep deprivation is a more recent finding postburn. [1][2][3][4][5][6][7] Sleep deprivation is a more recent finding postburn.…”

mentioning

confidence: 99%

Quantity and Quality of Nocturnal Sleep Affect Morning Glucose Measurement in Acutely Burned Children

Mayes

Gottschlich

Simakajornboon

et al. 2013

Journal of Burn Care & Research

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Hyperglycemia after severe burn injury has long been recognized, whereas sleep deprivation after burns is a more recent finding. The postburn metabolic effects of poor sleep are not clear despite reports in other populations demonstrating the association between sleep insufficiency and deleterious endocrine consequences. The aim of this study was to determine whether a relationship between sleep and glucose dynamics exists in acutely burned children. Two overnight polysomnography runs (2200 to 0600) per subject were conducted in 40 patients with a mean (± SEM) age of 9.4 ± 0.7 years, 50.1 ± 2.9% TBSA burn, and 43.2 ± 3.6% full-thickness injury. Serum glucose was drawn in the morning (0600) immediately after the sleep test. Insulin requirements during the 24-hour period preceding the 0600 glucose measurement were recorded. Generalized linear models were used by the authors to evaluate percent time in each stage of sleep, percent wake time, total sleep time, sleep efficiency, and morning serum glucose, accounting for insulin use. Increased time awake (P = .04, linear; P = .02, quadratic) and reduced time spent in stage 1 sleep (P = .03, linear) were associated with higher glucose levels. Sleep efficiency (P = .01, linear; P = .02, quadratic) and total sleep time (P = .01 linear; P = .02, quadratic) were inversely associated with glucose level. Morning glucose levels appear to be affected by the quality and quantity of overnight sleep in children who have sustained extensive burn injuries. Future research is needed to elucidate the metabolic and neuroendocrine consequences of sleep deprivation on metabolism after burns.

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The Syndrome of Dehydration, Coma and Severe Hyperglycemia without Ketosis in Patients Convalescing from Burns

Cited by 51 publications

References 33 publications

Practical aspects of intensive insulinization in the intensive care unit

Practical aspects of intensive insulinization in the intensive care unit

Hyperosmolar States in the Chronically Ill

Quantity and Quality of Nocturnal Sleep Affect Morning Glucose Measurement in Acutely Burned Children

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