Case 55 Drowsiness bordering on coma
Kerry Layne in 100 Cases in Acute Medicine, 2012
The hyperosmolar hyperglycaemic state is characterized by severe hyperglycaemia (typically a plasma glucose level >35 mmol/L) and hyperosmolality (serum osmolality >340 mosmol/kg) which can be assessed from 2[Na+] + 2[K+] + [urea] + [glucose]. In this case, the serum osmolality works out to be 379 mosmol/kg. He has a mild metabolic acidosis but significant ketoacidosis is not present (pH >7.3 and only a trace of ketones in the urine). This condition mostly occurs in those with type 2 diabetes, in contrast to diabetic ketoacidosis which occurs in type 1 diabetes. However, the distinction is not absolute and up to a third of cases can present with both elements.
Diabetes basics
Erica Whettem in Nursing & Health Survival Guide, 2014
Diabetes, more properly diabetes mellitus, is a complex chronic metabolic/endocrine disorder characterized by loss of normal blood glucose regulation and hyperglycaemia. Blood glucose levels are regulated by the pancreas. The beta cells secrete a steady supply of background insulin, ensuring availability of glucose to tissues at all times, with an extra burst of insulin output in response to a glucose load. Diabetes can be secondary to pancreatic impairment due to surgery and conditions such as cystic fibrosis, pancreatitis and haemochromatosis. Gestational diabetes is a first diagnosis of diabetes in pregnancy. An oral glucose tolerance test (OGTT) measures fasting venous plasma glucose prior to a 75g oral glucose load, then measures venous plasma glucose again 2 hours later. Diabetes not only carries the risk of acute short-term complications, such as diabetic ketoacidosis (DKA), hyperosmolar hyperglycaemic state (HHS) and hypoglycaemia, it is also associated with a range of disabling and life-threatening long-term complications.
The patient with acute endocrine problems
Ian Peate, Helen Dutton in Acute Nursing Care, 2014
This chapter identifies the key roles and functions of the endocrine system and appreciates how disordered physiology can disrupt homeostasis and cause a medical emergency. It defines the nurse's role in recognising and responding appropriately to patients with acute endocrine problems. Most endocrine emergencies occur rarely, diabetic emergencies are witnessed by most nurses caring for patients within the hospital setting. It is important therefore that nurses have insight into glucose metabolism and control and into their responsibilities in monitoring and managing this aspect of patient care. Endocrine malfunction can occur acutely include thyrotoxicosis, acute adrenal insufficiency and the seldom witnessed catecholamine crisis and it can present with severe patient deterioration, so a basic understanding of the endocrine system and associated hormones is required. In the hospital setting, it is claimed by Kearney and Dang that with improved care and early detection, diabetic ketoacidosis (DKA) and hyperglycaemic hyperosmolar syndrome (HHS) is prevented entirely.
Ten pivotal questions about diabetic ketoacidosis
Published in Postgraduate Medicine, 2001
Mary F. Carroll, David S. Schade
PREVIEW Nearly all physicians have cared for patients with diabetic ketoacidosis sometime during their training or have encountered patients with hyperglycemia and ketonuria in their office practice. In the last decade, many studies have challenged the traditional concepts about diabetic ketoacidosis treatment, resulting in sometimes confusing recommendations. In this article, Drs Carroll and Schade answer 10 frequently asked questions about the diagnosis and treatment of diabetic ketoacidosis and discuss related hospitalization issues.
Acute pancreatitis secondary to hypertriglyceridemia precipitated by diabetic ketoacidosis in a previously undiagnosed ketosis-prone patient with diabetes mellitus
Published in Baylor University Medical Center Proceedings, 2018
Vignesh Ramachandran, Diana M. Vila, John M. Cochran, Andrew C. Caruso, Rajeev Balchandani
ABSTRACT Diabetic ketoacidosis is a potentially fatal complication of diabetes mellitus that may result in hypertriglyceridemia. Rarely, the resulting hypertriglyceridemia may precipitate acute pancreatitis. We report a case of acute pancreatitis secondary to hypertriglyceridemia precipitated by diabetic ketoacidosis and postulate that this unusual presentation is due to the patient being prone to ketosis.
A sudden onset of diabetic ketoacidosis and acute pancreatitis after introduction of mizoribine therapy in a patient with rheumatoid arthritis
Published in Modern Rheumatology, 2008
Mizoribine has been recognized to have an acceptable toxicity profile compared with other immunosuppressants. In this study, however, we report a case of diabetic ketoacidosis and acute pancreatitis that suddenly occurred in a rheumatoid arthritis patient 2 weeks after introduction of mizoribine therapy. To the best of our knowledge, this is the first case in the literature to show mizoribine-induced diabetic ketoacidosis. Through prompt diagnosis and treatment, the patient recovered from these extremely rare but potentially lethal complications.
Related Knowledge Centers
- Diabetes Mellitus
- Insulin
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- Insulin Therapy
- Fatty Acid
- Ketone Bodies
- Diabetes Mellitus Type 1