scholarly journals Full recovery from extreme hypernatremia in an elderly woman with hyperosmolar hyperglycemic syndrome and abnormal electroencephalogram

2019 ◽  
Vol 7 ◽  
pp. 2050313X1984888 ◽  
Author(s):  
Yehuda Galili ◽  
Chad Gonzalez ◽  
Meghan Lytle ◽  
SJ Carlan ◽  
Mario Madruga
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Mental Status ◽  
Altered Mental Status ◽  
Fluid Replacement ◽  
Close Monitoring ◽  
Epileptiform Discharges ◽  
Hyperosmolar Hyperglycemic State

Background: Hyperosmolar hyperglycemic state is a life-threatening endocrine disorder that most commonly affects adults with type 2 diabetes mellitus. The condition results from an osmotic diuresis-induced loss of water exceeding that of sodium. Altered mental status, hypernatremia and hyperglycemia are characteristic features at presentation. Abnormal electroencephalogram findings have been reported. Successful therapy requires judicious fluid replacement and close monitoring. Case: A 78-year-old Hispanic female with a significant past medical history of type 2 diabetes mellitus was admitted with altered mental status, severe hypernatremia and hyperglycemia. She was diagnosed with hyperosmolar hyperglycemic state, and fluid therapy was started. A continuous electroencephalogram revealed left frontocentral and temporal periodic lateralized epileptiform discharges that resolved as her hypernatremia and dehydration were treated. She survived and was discharged after 1 week of treatment. Conclusion: Abnormal electroencephalogram findings consistent with nonconvulsive seizure activity may be temporary and reversible and do not suggest a poor prognosis in an elderly patient suffering from hyperosmolar hyperglycemic state and altered mental status.

scholarly journals Posterior reversible encephalopathy syndrome in a patient with diabetic ketonuria

2020 ◽  
Vol 8 (4) ◽  
pp. 231-234
Author(s):  
Ishwor Sharma ◽  
Prakash Banjade ◽  
Sasikumar Atthipalayam Chellamuthu ◽  
Faisal Saeed ◽  
Prajut Dallakoti
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Mental Status ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Stable Condition ◽  
Altered Mental Status ◽  
Posterior Reversible Encephalopathy ◽  
Reversible Encephalopathy

Posterior reversible encephalopathy syndrome is a condition presenting with non-specific symptoms like nausea, vomiting and headache along with neurological manifestations like altered mental status, seizure, visual impairment and even coma. These symptoms are coupled with characteristic radiological findings of vasogenic edema in the bilateral parieto-occipital lobe which is usually reversible. We present here, a young 30 years old male, with dizziness, vomiting, generalized weakness, altered mental status with cortical blindness and focal and generalized tonic-clonic seizures in the background of first presentation of type 2 diabetes mellitus with ketonuria. Characteristic findings in Magnetic Resonance Imaging and reversal of the symptoms helped to reach the diagnosis of posterior reversible encephalopathy syndrome in our patient. The patient was discharged in stable condition after reversal of the symptoms and treatment of type 2 diabetes mellitus.

Type II Diabetes Mellitus

2020 ◽  
Author(s):  
Matthew C. Riddle ◽  
Saul Genuth
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Normal Saline ◽  
Isotonic Saline ◽  
Free Water ◽  
Tissue Perfusion ◽  
Type Ii Diabetes Mellitus ◽  
Fluid Replacement

Hyperosmotic hyperglycemic nonketotic (HHNK) state (also known as hyperosmolar hyperglycemic state) is a significant acute complication of type 2 diabetes mellitus, especially for those over 65 years of age. It is characterized by extreme hyperglycemia and hyperosmolarity with little ketosis. The main clinical effect of extreme hyperosmolarity is somnolence or confusion. The absence of severe ketonemia is attributed to residual insulin secretion that is sufficient to restrain lipolysis. HHNK state is marked by extreme dehydration, with both a marked deficit of free water and serious compromise of intravascular volume and tissue perfusion. Most patients with HHNK state have hypotension, extremely dry mucous membranes, and gross elevation of urea nitrogen and creatinine. Urinary tract infection, pneumonia, stroke, myocardial infarction, and sepsis may precipitate HHNK state. Elderly patients are particularly vulnerable because their thirst mechanisms are less sensitive to a rising serum osmolality. Fluid replacement is the most important component of therapy for HHNK state. Restoration of circulating volume is an urgent first priority and is accomplished by relatively rapid intravenous infusion of 2 L of 0.9% normal saline followed by 0.45% normal saline. Later, when plasma glucose levels have declined to 250 to 300 mg/dL, 5% dextrose in water is given. Insulin treatment is started soon after administration of isotonic saline. Potassium must be added to intravenous fluids to prevent hypokalemia caused by insulin action but should not be started until hypokalemia is proven, because potassium levels can be high initially. The mortality from the HHNK state is high, ranging from 10 to 20%, and is most often from the precipitating illness. This review contains 6 figures, 7 tables, and 73 references. Key words: dehydration, fluid deficit, hyperglycemia, hyperglycemic nonketotic state, hyperosmolar, hyperosmotic insulin, potassium, type 2 diabetes mellitus

scholarly journals Fructose-induced severe hypertriglyceridemia and diabetes mellitus: a cautionary tale

2021 ◽  
Vol 2021 ◽  
Author(s):  
Ana Dugic ◽  
Michael Kryk ◽  
Claudia Mellenthin ◽  
Christoph Braig ◽  
Lorenzo Catanese ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Diabetic Ketoacidosis ◽  
Fruit Juice ◽  
Metabolic Effects ◽  
Newly Diagnosed ◽  
Severe Hypertriglyceridemia ◽  
Hyperosmolar Hyperglycemic State

Summary Drinking fruit juice is an increasingly popular health trend, as it is widely perceived as a source of vitamins and nutrients. However, high fructose load in fruit beverages can have harmful metabolic effects. When consumed in high amounts, fructose is linked with hypertriglyceridemia, fatty liver and insulin resistance. We present an unusual case of a patient with severe asymptomatic hypertriglyceridemia (triglycerides of 9182 mg/dL) and newly diagnosed type 2 diabetes mellitus, who reported a daily intake of 15 L of fruit juice over several weeks before presentation. The patient was referred to our emergency department with blood glucose of 527 mg/dL and glycated hemoglobin (HbA1c) of 17.3%. Interestingly, features of diabetic ketoacidosis or hyperosmolar hyperglycemic state were absent. The patient was overweight with an otherwise unremarkable physical exam. Lipase levels, liver function tests and inflammatory markers were closely monitored and remained unremarkable. The initial therapeutic approach included i.v. volume resuscitation, insulin and heparin. Additionally, plasmapheresis was performed to prevent potentially fatal complications of hypertriglyceridemia. The patient was counseled on balanced nutrition and detrimental effects of fruit beverages. He was discharged home 6 days after admission. At a 2-week follow-up visit, his triglyceride level was 419 mg/dL, total cholesterol was 221 mg/dL and HbA1c was 12.7%. The present case highlights the role of fructose overconsumption as a contributory factor for severe hypertriglyceridemia in a patient with newly diagnosed diabetes. We discuss metabolic effects of uncontrolled fructose ingestion, as well as the interplay of primary and secondary factors, in the pathogenesis of hypertriglyceridemia accompanied by diabetes. Learning points Excessive dietary fructose intake can exacerbate hypertriglyceridemia in patients with underlying type 2 diabetes mellitus (T2DM) and absence of diabetic ketoacidosis or hyperosmolar hyperglycemic state. When consumed in large amounts, fructose is considered a highly lipogenic nutrient linked with postprandial hypertriglyceridemia and de novo hepatic lipogenesis (DNL). Severe lipemia (triglyceride plasma level > 9000 mg/dL) could be asymptomatic and not necessarily complicated by acute pancreatitis, although lipase levels should be closely monitored. Plasmapheresis is an effective adjunct treatment option for rapid lowering of high serum lipids, which is paramount to prevent acute complications of severe hypertriglyceridemia.

scholarly journals Study of glycemic gap in hyperglycemic emergencies of type 2 diabetes mellitus

2018 ◽  
Vol 6 (4) ◽  
pp. 1151
Author(s):  
Periyasamy Sivakumar ◽  
Thiyagarajan Manjuladevi Moonishaa ◽  
Neethu George
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Biochemical Parameters ◽  
Plasma Osmolality ◽  
Study Groups ◽  
Hyperosmolar Hyperglycemic State ◽  
Study Population ◽  
The Relationship

Background: Type 2 diabetes mellitus (T2DM) is associated with two serious hyperglycemic emergencies namely Diabetic ketoacidosis (DKA) and Hyperosmolar hyperglycemic state (HHS). The aim of the study was to determine the usefulness of glycemic gap in T2DM patients with DKA and HHS.Methods: T2DM cases above 20 years of age were included in this study. The study population was divided into three broad groups as T2DM without hyperglycemic emergencies, T2DM with DKA, T2DM with HHS, with 50 subjects in each group. Glycemic gap was calculated in the study population and compared between the three groups. The relationship between glycemic gap and the conventional indicators of severity in hyperglycemic emergencies of T2DM were determined.Results: Of the three study groups, T2DM cases with HHS presented with substantial alterations in the baseline biochemical parameters. The glycemic gap was also highly elevated in the HHS cases than the others. Glycemic gap showed significant correlation only with plasma osmolality of the HHS cases.Conclusions: Elevated glycemic gap indicating stress induced hyperglycemia (SIH) occur in hyperglycemic emergencies of T2DM, especially HHS. 

Type II Diabetes Mellitus

2020 ◽  
Author(s):  
Matthew C. Riddle ◽  
Saul Genuth
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Normal Saline ◽  
Isotonic Saline ◽  
Free Water ◽  
Tissue Perfusion ◽  
Type Ii Diabetes Mellitus ◽  
Fluid Replacement

Hyperosmotic hyperglycemic nonketotic (HHNK) state (also known as hyperosmolar hyperglycemic state) is a significant acute complication of type 2 diabetes mellitus, especially for those over 65 years of age. It is characterized by extreme hyperglycemia and hyperosmolarity with little ketosis. The main clinical effect of extreme hyperosmolarity is somnolence or confusion. The absence of severe ketonemia is attributed to residual insulin secretion that is sufficient to restrain lipolysis. HHNK state is marked by extreme dehydration, with both a marked deficit of free water and serious compromise of intravascular volume and tissue perfusion. Most patients with HHNK state have hypotension, extremely dry mucous membranes, and gross elevation of urea nitrogen and creatinine. Urinary tract infection, pneumonia, stroke, myocardial infarction, and sepsis may precipitate HHNK state. Elderly patients are particularly vulnerable because their thirst mechanisms are less sensitive to a rising serum osmolality. Fluid replacement is the most important component of therapy for HHNK state. Restoration of circulating volume is an urgent first priority and is accomplished by relatively rapid intravenous infusion of 2 L of 0.9% normal saline followed by 0.45% normal saline. Later, when plasma glucose levels have declined to 250 to 300 mg/dL, 5% dextrose in water is given. Insulin treatment is started soon after administration of isotonic saline. Potassium must be added to intravenous fluids to prevent hypokalemia caused by insulin action but should not be started until hypokalemia is proven, because potassium levels can be high initially. The mortality from the HHNK state is high, ranging from 10 to 20%, and is most often from the precipitating illness. This review contains 6 figures, 7 tables, and 73 references. Key words: dehydration, fluid deficit, hyperglycemia, hyperglycemic nonketotic state, hyperosmolar, hyperosmotic insulin, potassium, type 2 diabetes mellitus

1045-P: Impact of Type 2 Diabetes Mellitus with Hyperosmolar Hyperglycemic State on Patients Admitted for Heart Failure: Insights from the National Inpatient Sample

Diabetes ◽  
2021 ◽  
Vol 70 (Supplement 1) ◽  
pp. 1045-P
Author(s):  
IRIAGBONSE R. ASEMOTA ◽  
HAFEEZ SHAKA ◽  
EHIZOGIE EDIGIN ◽  
MUHAMMAD USMAN ALMANI ◽  
EMMANUEL AKUNA
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
National Inpatient Sample ◽  
Hyperosmolar Hyperglycemic State

Type II Diabetes Mellitus

2020 ◽  
Author(s):  
Matthew C. Riddle ◽  
Saul Genuth
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Normal Saline ◽  
Isotonic Saline ◽  
Free Water ◽  
Tissue Perfusion ◽  
Type Ii Diabetes Mellitus ◽  
Fluid Replacement

Hyperosmotic hyperglycemic nonketotic (HHNK) state (also known as hyperosmolar hyperglycemic state) is a significant acute complication of type 2 diabetes mellitus, especially for those over 65 years of age. It is characterized by extreme hyperglycemia and hyperosmolarity with little ketosis. The main clinical effect of extreme hyperosmolarity is somnolence or confusion. The absence of severe ketonemia is attributed to residual insulin secretion that is sufficient to restrain lipolysis. HHNK state is marked by extreme dehydration, with both a marked deficit of free water and serious compromise of intravascular volume and tissue perfusion. Most patients with HHNK state have hypotension, extremely dry mucous membranes, and gross elevation of urea nitrogen and creatinine. Urinary tract infection, pneumonia, stroke, myocardial infarction, and sepsis may precipitate HHNK state. Elderly patients are particularly vulnerable because their thirst mechanisms are less sensitive to a rising serum osmolality. Fluid replacement is the most important component of therapy for HHNK state. Restoration of circulating volume is an urgent first priority and is accomplished by relatively rapid intravenous infusion of 2 L of 0.9% normal saline followed by 0.45% normal saline. Later, when plasma glucose levels have declined to 250 to 300 mg/dL, 5% dextrose in water is given. Insulin treatment is started soon after administration of isotonic saline. Potassium must be added to intravenous fluids to prevent hypokalemia caused by insulin action but should not be started until hypokalemia is proven, because potassium levels can be high initially. The mortality from the HHNK state is high, ranging from 10 to 20%, and is most often from the precipitating illness. This review contains 6 figures, 7 tables, and 73 references. Key words: dehydration, fluid deficit, hyperglycemia, hyperglycemic nonketotic state, hyperosmolar, hyperosmotic insulin, potassium, type 2 diabetes mellitus

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