COVID-19 Vaccine Related Hyperosmolar Hyperglycemic State and Normalized Glycemia within 2 Months

Abstract Introduction: Patients with underlying heart failure (HF) are at increased risk for hyperosmolar hyperglycemic state (HHS). However, no studies have investigated whether the presence of existing HF would impact the outcomes of HHS. Objective: we aimed to study the impact of heart HF on outcomes of HHS among adult patients hospitalized for HHS. Methodology: The National Inpatient Sample (NIS) was queried for all patients who were admitted with a diagnosis of hyperosmolar hyperglycemic state during the years 2005-2014. The primary outcomes of the study were all-cause mortality, acute myocardial infarction (MI), acute stroke. The secondary outcomes were acute kidney injury (AKI), rhabdomyolysis, acute respiratory failure (ARF), need for mechanical ventilation (MV), length of stay (LOS), and total cost of stay. Results: Overall, 188,725 patients were admitted for hyperosmolar hyperglycemic state. Mean age was 55.9 (SEM: 0.1). Females were (43.9%), Caucasians were 37.4% while African American were 35.2%. Total mortality was 1.1%, MI was 1.3% and stroke was 1.1%. Most common secondary outcome was AKI seen in 31.3% followed by ARF seen in 2.9% of total. The mean cost was 7887 $ (SEM: 84.6) and mean LOS was 4.1 days (SEM: 0.03). Patients with heart failure had higher rates for mortality 2% vs 0.9%, p<0.001, MI 3.1% vs 1.1 % p<0.001 and stroke 1.6% vs 1%, p<0.001. In addition, they had higher rates for AKI, ARF, need for mechanical ventilation, length of stay and cost. No significant difference on risk for rhabdomyolysis. On multivariable analysis, patients with heart failure had higher odds for mortality adjusted odd’s ratio (a OR) 1.58 [95%CI: 1.15-2.17] p<0.01 and higher risk for stroke a OR 1.43 [95%CI:1.04-1.95] p=0.03. In addition, presence of heart failure significantly correlated with ARF, need for mechanical ventilation, higher cost and longer LOS. No significant association was demonstrated between heart failure and risk for Rhabdomyolysis, MI and AKI. Conclusion: Diabetic patients with heart failure who develop hyperosmolar hyperglycemic state are at higher risk for stroke and mortality and respiratory failure. Particular attention on fluid balance as well as early recognition for signs of stroke is warranted.

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A rare case of acute renal failure: rhabdomyolysis due to hyperosmolar hyperglycemic state

Endocrine Abstracts ◽

10.1530/endoabs.41.ep530 ◽

2016 ◽

Author(s):

Tugrul Burak Genc ◽

Yildiz Okuturlar ◽

Hakan Kocoglu ◽

Samet Sayilan ◽

Yesim Ozdem Inan ◽

...

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Rare Case ◽

Hyperosmolar Hyperglycemic State

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A Snapshot of Risk Stratification of Diabetic Patients Fasting during the Month of Ramadan

10.53350/pjmhs2115123427 ◽

2021 ◽

Vol 15 (12) ◽

pp. 3427-3429

Author(s):

Asim Hassan ◽

Wedad Abullah Aldahasai ◽

Shayma Abdulatif Alsalmi

Keyword(s):

Diabetes Mellitus ◽

High Risk ◽

Risk Stratification ◽

Armed Forces ◽

Hypoglycemic Agents ◽

Diabetic Patients ◽

Clinical Practices ◽

Oral Hypoglycemic Agents ◽

Hyperosmolar Hyperglycemic State ◽

Risk Patients

Objectives: To get a clinical snapshot of the diabetic patients who planned to fast during the month of Ramadan and to determine the ability of the RRR application to effectively risk-stratify patients. Study Design: Observational study. Place and Duration of Study: Department of Diabetes & Endocrinology, Armed Forces Hospital Al-Hada, Taif, Kingdom of Saudi Arabia from 1st April 2018 to 31st May 2018. Methodology: Ninety six patients over 15 years of age with diabetes mellitus were risk stratified using standardized risk criteria were enrolled. Detailed analysis of the information was performed to paint a clinical landscape of the patients who intended to fast. Results: Seventy four percent of the patients were type 2 diabetics, 11% GDM, 31% were between 60-70 years and 17 % had diabetes for more than 20 years. 17% of participants had serious complications during the last three months before Ramadan including hypoglycemia, Diabetic Ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). 59% had chronic diabetic complications. 28 % of patients were on both insulin and oral hypoglycemic agents (OHA) together and 16 % on high risk medications. 25% of patients had an HbA1C of more than 10%. Pertaining to the previous Ramadan experience 19% disclosed having serious complications in the past. 6 % were categorized as low risk individuals, 76% as moderate, 6% high and 12 % as very high risk. Conclusions: Astonishingly all the patients advised to refrain from fasting insisted on fasting. Considering the latest IDF numbers the above calculated percentages would translate into very huge numbers who are in serious jeopardy. In order to prevent serious consequences it is highly recommends that evidence based and validated risk stratification strategies are implemented in routine clinical practices. Keywords: Diabetes mellitus, Fast, Hypoglycemia, High risk patients

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Antibody-Mediated Extreme Insulin Resistance: The Importance of Pre-Treatment Screening

Case Reports in Endocrinology ◽

10.1155/2019/8562546 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5

Author(s):

Tina Mosaferi ◽

Sahar Sherf ◽

Laura Y. Sue ◽

Ines Donangelo

Keyword(s):

Insulin Resistance ◽

Latent Tuberculosis ◽

Abrupt Onset ◽

Immunomodulatory Therapy ◽

Intravenous Insulin ◽

Hyperosmolar Hyperglycemic State ◽

History Of ◽

Pre Treatment ◽

New Diagnosis ◽

Hispanic Male

We report the case of a 56 year-old Hispanic male with a 10-year history of type 2 diabetes who presented with abrupt onset of hyperglycemia resistant to escalating doses of intravenous insulin infusion (>2500 units daily). He was diagnosed with antibody-mediated insulin resistance given the presence of hyperglycemia despite receiving >200 units insulin/day, a lack of identifiable precipitants for diabetic ketoacidosis or hyperosmolar hyperglycemic state, and elevated insulin antibodies. He underwent pre-immunomodulatory therapy screening for infections, rheumatologic disorders, and malignancy, which uncovered a new diagnosis of latent tuberculosis. While concurrently being treated for latent tuberculosis, he successfully responded to immunomodulatory therapy with rituximab, dexamethasone, and cyclophosphamide. Insulin was discontinued completely, and he maintained appropriate glycemic control on oral diabetic agents (metformin and pioglitazone). This case supports the use of immunomodulatory therapy for the treatment of antibody-mediated insulin resistance and highlights the importance of pre-immunomodulatory therapy screening to uncover occult infection or identify underlying neoplastic/rheumatologic disease prior to immunosuppression.

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Clinical characteristics and outcome in patients with combined diabetic ketoacidosis and hyperosmolar hyperglycemic state associated with COVID-19: A retrospective, hospital-based observational case series

Diabetes Research and Clinical Practice ◽

10.1016/j.diabres.2020.108279 ◽

2020 ◽

Vol 166 ◽

pp. 108279 ◽

Cited By ~ 6

Author(s):

Kok Hoe Chan ◽

Divya Thimmareddygari ◽

Amr Ramahi ◽

Liana Atallah ◽

Nicholas G. Baranetsky ◽

...

Keyword(s):

Diabetic Ketoacidosis ◽

Clinical Characteristics ◽

Case Series ◽

Hyperosmolar Hyperglycemic State

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Muscle relaxant induced pancreatitis leading to hyperosmolar hyperglycemic state

Oxford Medical Case Reports ◽

10.1093/omcr/omz012 ◽

2019 ◽

Vol 2019 (3) ◽

Cited By ~ 1

Author(s):

Yicheng K Bao ◽

Vishwanath C Ganesan ◽

Winston Jiang ◽

Lydia Lin ◽

Norwood R Brown ◽

...

Keyword(s):

Muscle Relaxant ◽

Hyperosmolar Hyperglycemic State

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MON-084 Hyperosmolar Hyperglycemic State as Initial Presentation of Type 1 Diabetes in Children

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.975 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Fabiola D’Ambrosio ◽

Isabella Marranzini-Rodriguez ◽

Roxana Aguirre Castaneda ◽

Claudia Boucher-Berry

Keyword(s):

African American ◽

Early Recognition ◽

Fluid Management ◽

Low Frequency ◽

Serum Glucose ◽

African American Female ◽

Appropriate Treatment ◽

Hyperosmolar Hyperglycemic State ◽

History Of ◽

Sugary Beverages

Abstract INTRODUCTION: We present 2 pediatric patients with Hyperosmolar Hyperglycemic State (HHS) at diabetes onset. CASE 1: 3 year old African American female presented to the pediatrician office with a 5 day history of polydipsia, polyuria and emesis. POCT glucose read high and patient was transferred to the PICU. Laboratory studies were significant for serum glucose of 1032 mg/dl, Na 128 mMOL/L (corrected 142mMOL/L), VBG showed pH 7.36, HCO3 20 mMOL/L, Serum osm 331 mOsm/Kg. Patient received a 20ml/kg bolus of 0.9%NaCl, followed by 2 times maintenance IV fluids and glargine 2 units. Glucose dropped from 418 to 122 mg/dl in 3 hours. Due to this Dextrose was added and IVF rate was decreased. CASE 2: 8 year old African American obese male was admitted to the PICU for management of new onset diabetes. He presented with 3 days of flu-like symptoms and worsening drowsiness. Patient had increased consumption of large quantities of sugary beverages due to increased thirst. Laboratory workup: serum glucose of 2309 mg/dl, Na 133 mMOL/L (corrected 168 mMOL/L), pH 7.13, HCO3 10 mMOL/L. Patient was given 30 cc/kg NS bolus followed by an insulin drip of 0.1 u/kg/hour. Repeat studies 3 hours later showed a serum glucose of 1,414 mg/dl, Na 152 mMol/L (corrected 184 mMOL/L), pH 7.19, HCO3 17 mMOL/L, and serum osmolality of 408 mOsm/Kg. IVF were adjusted to correct the water deficit and insulin drip was decreased to 0.05u/kg/hour. DISCUSSION: HHS continues to be a challenging diagnosis due to its low frequency compared with Diabetic Ketoacidosis especially when presenting at a very young age. Most practitioners will mistake the presentation for DKA and start an insulin drip. The early use of insulin is not necessary in the setting of HHS due to the risk of complications. A fast drop in glucose decreases the osmotic pressure and compromises the circulatory status with a higher chance of thromboembolism. In mixed HHS and DKA, the management aligns more with the DKA management but the amount of fluids needed is higher and insulin infusion may cause fast drop of glucose with potential decrease of intravascular volume as in our second patient. It is imperative that the diagnosis of HHS is made early so that the appropriate treatment can be instituted. CONCLUSION: Appropriate fluid administration and delay in insulin administration are key in the management of HHS. The awareness of this possible presentation and the early recognition and appropriate fluid management are needed to improve outcomes. REFERENCE: Zeitler, Phil, et al. “Hyperglycemic Hyperosmolar Syndrome in Children: Pathophysiological Considerations and Suggested Guidelines for Treatment.” The Journal of Pediatrics, vol. 158, no. 1, 2011, doi:10.1016/j.jpeds.2010.09.048

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