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Diabetic emergencies: Diabetic ketoacidosis and hyperosmolar hyperglycemic state
Published in Nadia Barghouthi, Jessica Perini, Endocrine Diseases in Pregnancy and the Postpartum Period, 2021
Sejal Doshi, Harikrashna Bhatt
Incidence and prevalenceIn the general population, diabetic ketoacidosis (DKA) accounts for 8–29% of all diabetic-related hospital admissions in the United States.The incidence of hospitalizations for hyperosmolar hyperglycemic state (HHS) pales in comparison at <1%.1,2The incidence of DKA is higher in pregnant patients at close to 9% as opposed to 3% in the nonpregnant population.Multiple epidemiologic studies have reported the occurrence of DKA to be highest in children and young adults with type I DM, whereas HHS is usually seen in the older, type II diabetic population.3 Nevertheless, there is considerable overlap in the incidence of both disease entities among all age groups and diabetic types.Analyses of the international diabetes registry databases in Germany, Austria, the United States, and England demonstrated that females were at higher risk for developing DKA compared to males.4
Management of Diabetes Mellitus in Sub-Saharan Africa
Published in Emmanuel C. Opara, Sam Dagogo-Jack, Nutrition and Diabetes, 2019
Olufemi A. Fasanmade, Amie A. Ogunsakin, Sam Dagogo-Jack
In a retrospective study of the admission pattern in a tertiary center in Lagos, Nigeria, a total of 1,703 patients were admitted through the adult emergency wards during the period March 2011 to February 2012. Diabetes-related admissions comprised 166 (9.74%) of total medical admissions, with a case fatality rate of 21.6%.49 The leading causes of death were hyperglycemic emergencies (diabetic ketoacidosis, hyperosmolar hyperglycemic states, and other mixed hyperglycemic emergencies), hypoglycemia, and DMFS. In a similar study in Port Harcourt, Nigeria, the case fatality of diabetes-related admissions was 17%, and the leading causes of mortality were acute metabolic complications (hyperglycemic and hypoglycemic emergencies) seen in 39.8% of the subjects.46 In yet another retrospective study, 8.8% of inpatients admitted with diabetes died (70% of deaths occurring within the first week of admission).50 These dismal data have been replicated at other locations.33,46–48,51–53 In neighboring Ghana, in a study conducted between 1983 and 2014, the most common reasons for diabetes-related hospital admissions were hyperglycemic emergencies (accounting for 80%) and cardiovascular-related causes. Case fatality in that study ranged from 15% to 21%.54
Acute Mental Status Change
Published in Lauren A. Plante, Expecting Trouble, 2018
Matthew K. Hoffman, Victoria Greenberg
Water follows glucose in the urine, causing dehydration and a hyperosmolar state. Over time, the patient cannot adequately compensate with increased fluid intake. These patients look very similar to DKA patients but do not have ketosis. Hyperglycemic hyperosmolar nonketotic (HHNK) coma initially presents with confusion and lethargy and then progresses to obtundation and coma. The management of HHNK is similar to the management of DKA. The treatment of hyperosmolar hyperglycemic state includes fluid resuscitation, correction of electrolyte imbalances, and regular insulin to correct hyperglycemia at a rate of 0.1 units/kg/hour (6).
Bacteremia in patients with diabetic ketoacidosis: a cross-sectional study
Published in Hospital Practice, 2023
Naoto Ishimaru, Toshio Shimokawa, Takahiro Nakajima, Yohei Kanzawa, Saori Kinami
Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are medical emergencies in people with diabetes mellitus [1]. DKA manifests as hyperglycemia (or history of diabetes), ketonemia and metabolic acidosis, whereas HHS manifests as severe hyperglycemia, high serum osmolality and dehydration [1]. The presentations of both entities can overlap [2]. The number of hospital admissions for DKA is increasing [3,4], with high socioeconomical burden [5,6]. Mortality of patients with DKA is reported to be below 1% [3]; although it is higher, as much as 5%, in elderly patients and in those with life-threatening comorbidities [7]. The rate of mortality from HHS can range between 12 and 16% [2,8]. Infection is reported to be the most common precipitating factor for DKA [9] and is associated with approximately 30% of the cases of DKA and HHS [2]. Among infectious diseases, bacteremia is associated with high morbidity and mortality with a substantial burden in various countries, including Japan [10–12]. However, information on incidence of bacteremia in patients with DKA and HHS has been scarce.
Treatment-related transient splenial lesion of the Corpus Callosum in patients with neuropsychiatric disorders: a literature overview with a case report
Published in Expert Opinion on Drug Safety, 2020
Giovanna Cirnigliaro, Ilaria Di Bernardo, Valentina Caricasole, Eleonora Piccoli, Barbara Scaramelli, Simone Pomati, Chiara Villa, Leonardo Pantoni, Bernardo Dell’Osso
Finally, three cases of transient SCC lesion were identified in conjunction with neuroleptic malignant syndrome [41,42,45]. As can be reconstructed from the clinical-anamnestic data provided in two of these case reports, the most plausible hypothesis is that the NMS was caused by neuroleptic drugs. To solve it, clinicians stopped the entire psychiatric therapy, including the AEDs that had been given as mood stabilizers [42,45]. The SCC lesion might have arisen as a result of the sudden interruption of AEDs and would not have been a manifestation of the NMS nor this would have caused it. The third reported case is different because no AED was administered [41]. Olanzapine had triggered a NMS and at the same time a hyperosmolar hyperglycemic state (HHS) had arisen. Authors speculated that both HHS and NMS might have contributed to the pathophysiology of SCC lesion by inducing hypernatremia [41].
Steroid-induced psychosis
Published in Baylor University Medical Center Proceedings, 2019
Michael Janes, Shaw Kuster, Tove M. Goldson, Samuel N. Forjuoh
The Diagnostic and Statistical Manual of Mental Disorders, fifth edition, categorizes steroid-induced psychosis as a form of substance/medication-induced psychotic disorder.1 For steroid-induced psychosis to be diagnosed, a number of criteria must be met. First, the patient must have at least delusions or hallucinations after exposure to a medication capable of producing these symptoms. The disturbance cannot be better explained by a non–medication-induced psychotic disorder, and it does not occur exclusively during the course of a delirium. Finally, it must cause clinically significant distress or functional impairment. These requirements make the condition a diagnosis of exclusion and therefore a physician must rule out other potential differential diagnoses of other medications, drug use, intoxication, electrolyte imbalance, infection, hypoglycemia, hyperglycemia, neoplasms, or known psychiatric causes. Although our patient had hyperglycemia, the amount of glucose in his system would be very unlikely to cause a hyperosmolar hyperglycemic state, and he had no changes to his tramadol prescription and had been stable on that dosage.