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hyperglycemic crises

Ivan Kruljac, Miroslav Ćaćić, Petra Ćaćić, Vedran Ostojić, Mario Štefanović, Aljoša Šikić, Milan Vrkljan
Patients with type 2 diabetes mellitus have impaired ketogenesis due to high serum insulin and low growth hormone levels. Evidence exists that ketone bodies might improve kidney and cardiac function. In theory, improved ketogenesis in diabetics may have positive effects. We aimed to assess the impact of diabetic ketosis on all-cause mortality in patients with type 2 diabetes mellitus presenting with hyperglycemic crisis. We analyzed 486 patients with diabetic ketosis and 486 age and sex-matched patients with non-ketotic hyperglycemia presenting to the emergency department...
September 3, 2016: Endocrine
Priyathama Vellanki, Dawn D Smiley, Darko Stefanovski, Isabel Anzola, Wenlan Duan, Megan Hudson, Limin Peng, Francisco J Pasquel, Guillermo E Umpierrez
OBJECTIVE: After intensive insulin treatment, many obese African American patients with new-onset diabetic ketoacidosis (DKA) and severe hyperglycemia are able to achieve near-normoglycemia remission. The optimal treatment to prevent hyperglycemic relapses after remission is not known. RESEARCH DESIGN AND METHODS: This prospective, 4-year, placebo-controlled study randomly assigned 48 African American subjects with DKA and severe hyperglycemia to metformin 1,000 mg daily (n = 17), sitagliptin 100 mg daily (n = 16), or placebo (n = 15) after normoglycemia remission...
August 29, 2016: Diabetes Care
Nicoletta Villa, Agnese Scatigno, Serena Redaelli, Donatella Conconi, Paola Cianci, Clotilde Farina, Chiara Fossati, Leda Dalprà, Silvia Maitz, Angelo Selicorni
BACKGROUND: Segmental duplication of the long arm of chromosome 14 (14q) has commonly been reported to affect the proximal segment of 14q, while distal duplication is a rare condition and often associated with segmental monosomy of other chromosomes. CASE PRESENTATION: We report the clinical and genetic characterization of a 4-year-old male patient with 14q32.3-qter trisomy resulting from an adjacent segregation of a paternal reciprocal translocation (14;21)(q32...
2016: Molecular Cytogenetics
Jagdeesh Ullal, Raymie McFarland, Margaret Bachand, Joseph Aloi
BACKGROUND: Efforts at improving quality metrics in diabetes focus on minimizing adverse events and avoiding re-admissions to the hospital. Our experience with Glucommander™ (Glytec, Greenville, SC), a cloud-based insulin management software system, suggested that its use in the emergency department (ED) would be useful in treating patients with mild diabetic ketoacidosis (DKA). MATERIALS AND METHODS: Thirty-five patients seen in the ED with hyperglycemic crises and diagnosed with DKA during one calendar year were reviewed...
February 2016: Diabetes Technology & Therapeutics
Nicholas Fusco, Jeffrey Gonzales, Siu Yan Amy Yeung
OBJECTIVE: To determine if treatment of DKA in a sample of adult medical intensive care unit (MICU) patients was consistent with the 2006 ADA Hyperglycemic Crises in Adult Patients with Diabetes Clinical Guidelines. METHODS: Medical records were reviewed for all adult patients admitted to a MICU with a diagnosis of DKA between July 1, 2007 and June 30, 2010. The primary composite endpoint assessed fluid resuscitation (total mL/kg) at 24 hours, insulin bolus dose, and continuous insulin infusion (units/kg or units/kg/hour) to determine whether the 2006 ADA clinical guidelines for Hyperglycemic Crises in Adult Patients with Diabetes were followed...
December 1, 2015: American Journal of Health-system Pharmacy: AJHP
Salam Ranabir
Type 1 diabetes mellitus is a challenging situation for both physician and patient, as it requires a very disciplined lifestyle with regular monitoring and follow-up. It becomes even more difficult when facilities are limited. Manipur has a difficult terrain and due to lack of adequate facilities patients face frequent hypoglycemic episodes and hyperglycemic crises. Continuous availability of insulin is not possible at all times. The health care workers in the state are not fully aware of right practices and incorrect injection sites and erroneous techniques are also quite prevalent...
April 2015: Indian Journal of Endocrinology and Metabolism
Darlene G McCombs, Susan J Appel, Marcie E Ward
PURPOSE: This practice improvement project was formulated to determine accuracy rate in differentiating between two hyperglycemic crises (diabetes ketoacidosis [DKA] and hyperosmolar hyperglycemic nonketotic syndrome [HHNKS]) in a clinical population of individuals who manifested hyperglycemia and diabetes mellitus (DM). We hypothesized that HHNKS was commonly misdiagnosed as DKA. Our primary aim was to determine frequency of correct HHNKS diagnoses. A second aim was to review the literature and present an evidence-based protocol to assist providers with the differential diagnosis of HHNKS from DKA...
August 2015: Journal of the American Association of Nurse Practitioners
Willy Chou, Min-Hsien Chung, Hsien-Yi Wang, Jiann-Hwa Chen, Wei-Lung Chen, How-Ran Guo, Hung-Jung Lin, Shih-Bin Su, Chien-Cheng Huang, Chien-Chin Hsu
AIMS/INTRODUCTION: Hyperglycemic crises without a history of diabetes have not been well studied. We compared the clinical characteristics of patients with and without a history of diabetes, and evaluated the glycated hemoglobin levels. MATERIALS AND METHODS: Consecutive adult patients (aged >18 years) visiting the emergency department (ED) between January 2004 and December 2010 were enrolled if they met the criteria for a hyperglycemic crisis. Patients were separated into those without and those with a history of diabetes...
November 2014: Journal of Diabetes Investigation
Juan Li, Minglian Huang, Xingping Shen
AIMS: To investigate the relationship between oxidative stress and serum levels of pro-inflammatory cytokines in diabetic patients with hyperglycemic crisis. METHODS: Seventy-three patients presenting to hospital with diabetic ketoacidosis or non-ketotic hyperglycemia were studied. Superoxide dismutase (SOD) activity, malondialdehyde (MDA) content, total antioxidant capacity (TAC), 8-iso-prostaglandin F2α (8-iso-prostaglandinF2α, 8-iso-PGF2α), tumor necrosis factor receptor-I (TNF-RI), interleukin -1β (IL-1β), tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) levels were measured in all patients...
September 2014: Journal of Diabetes and its Complications
D Benaiges, J J Chillarón, M J Carrera, F Cots, J Puig de Dou, E Corominas, J Pedro-Botet, J A Flores-Le Roux, C Claret, A Goday, J F Cano
BACKGROUND: The purpose of this prospective cohort study was to compare the costs of day hospital (DH) care for hyperglycemic crisis in elderly diabetic patients with those of conventional hospitalization (CH). Secondary objectives were to compare these two clinical scenarios in terms of glycemic control, number of emergency and outpatient visits, readmissions, hypoglycemic episodes, and nosocomial morbidity. METHODS: The study population comprised diabetic patients aged >74 years consecutively admitted to a tertiary teaching hospital in Spain for hyperglycemic crisis (sustained hyperglycemia [>300 mg/dL] for at least 3 days with or without ketosis)...
2014: Clinical Interventions in Aging
Yasufumi Miyake
The morbidity of hyperglycemic crises and acute hypoglycemic attacks in patients with diabetes mellitus has been increasing for the past several decades. One of the reasons for this is the increase in the number of patients with diabetes. The increased proportion of aging and isolation in society is another reason. The author has discussed patients with these complaints: their epidemiology, pathophysiology, and management in the emergency department. Hyperglycemic crises include diabetic ketoacidosis (DKA), hyperosmolar hyperglycemic syndrome (HHS), and lactic acidosis (LA)...
February 2014: Brain and Nerve, Shinkei Kenkyū No Shinpo
Jennifer Hackel
PURPOSE: The purpose of this case study is twofold: first, to present the pathophysiology of hyperosmolar hyperglycemic state (HHS) as it relates to a hospitalized patient with undiagnosed diabetes; the second is to increase awareness among primary care nurse practitioners (NPs) about the complexities of diagnosing less typical forms of diabetes. The case illustrates how HHS can be life threatening, how it is differentiated from diabetic ketoacidosis (DKA), and how it is treated. The importance of closer surveillance of blood glucose in high-risk individuals is highlighted...
November 2014: Journal of the American Association of Nurse Practitioners
Susumu Suzuki
A bad cold, the flu or a serious illness can make blood glucose too high in elderly person with diabetes. Gastrointestinal illnesses may cause hypoglycemia for individuals treated with insulin, sulfonylureas or glitinides. When the persons with diabetes discontinue insulin or diabetes medications because of appetite loss and reduced food intake, they may fall into diabetic crises, such as ketoacidosis, or hyperosmolar hyperglycemic syndrome. The elderly patients need to take extra precautions on sick days to avoid diabetic crises or hypoglycemia...
November 2013: Nihon Rinsho. Japanese Journal of Clinical Medicine
Dick Mul, Caroline R Meijer
Recently the Paediatric Association of the Netherlands (NVK) published a new guideline on the treatment of diabetic ketoacidosis (DKA) and hyperglycaemic hyperosmolar syndrome (HHS) in children and adolescents. DKA comprises hyperglycaemia, ketosis and acidosis. Cerebral oedema is a feared, life-threatening complication of DKA. HHS is characterized by hyperglycaemia, hyperosmolarity, severe dehydration, and little or no ketone production. Multi-organ failure, rhabdomyolysis and thrombosis are the most common complications...
2013: Nederlands Tijdschrift Voor Geneeskunde
Jelena Maletkovic, Andrew Drexler
Diabetic ketoacidosis (DKA) and the hyperglycemic hyperosmolar state (HHS) are potentially fatal hyperglycemic crises that occur as acute complications of uncontrolled diabetes mellitus. The authors provide a review of the current epidemiology, precipitating factors, pathogenesis, clinical presentation, evaluation, and treatment of DKA and HHS. The discovery of insulin in 1921 changed the life expectancy of patients with diabetes mellitus dramatically. Today, almost a century later, DKA and HHS remain significant causes of morbidity and mortality across different countries, ages, races, and socioeconomic groups and a significant economic burden for society...
December 2013: Endocrinology and Metabolism Clinics of North America
Faith Pollock, Donna C Funk
In acute diabetes conditions, management of the following 3 potential complications is required: diabetic ketoacidosis, hyperosmolar hyperglycemic state, and iatrogenic hypoglycemia. The hyperglycemic crises diabetic ketoacidosis and hyperosmolar hyperglycemic state are the 2 most serious metabolic complications of diabetes. Hypoglycemia, specifically iatrogenic hypoglycemia, results from treatments that raise circulating insulin levels and thus lower plasma glucose concentrations to an abnormally low level, which exposes the patient to potential harm...
July 2013: AACN Advanced Critical Care
Chien-Cheng Huang, Willy Chou, Hung-Jung Lin, Shih-Chung Chen, Shu-Chun Kuo, Wei-Lung Chen, Jiann-Hwa Chen, Hsien-Yi Wang, How-Ran Guo
BACKGROUND: Infection is the most common precipitating factor and cause of death in patients with hyperglycemic crises. Treating infection-precipitated hyperglycemic crises includes using empiric antibiotics early; correcting dehydration, hyperglycemia, and electrolyte imbalances; and frequent monitoring. Intensive care unit admission, broad-spectrum antibiotics, and even novel therapy for infection may be beneficial for patients with a high risk of mortality. However, these management options are costly and not beneficial for every patient...
2013: BMC Endocrine Disorders
Nicolas Gauthier, Jiang Wei Wu, Shu Pei Wang, Pierre Allard, Orval A Mamer, Lawrence Sweetman, Ann B Moser, Lisa Kratz, Fernando Alvarez, Yves Robitaille, François Lépine, Grant A Mitchell
Most conditions detected by expanded newborn screening result from deficiency of one of the enzymes that degrade acyl-coenzyme A (CoA) esters in mitochondria. The role of acyl-CoAs in the pathophysiology of these disorders is poorly understood, in part because CoA esters are intracellular and samples are not generally available from human patients. We created a mouse model of one such condition, deficiency of 3-hydroxy-3-methylglutaryl-CoA lyase (HL), in liver (HLLKO mice). HL catalyses a reaction of ketone body synthesis and of leucine degradation...
2013: PloS One
Jayme S Hara, Aryan J Rahbar, Meghan N Jeffres, Kenneth E Izuora
OBJECTIVE: The purpose of this study was to evaluate the efficacy and safety of an adult hyperglycemic crises protocol based upon the 2009 American Diabetes Association (ADA) consensus statement. METHODS: We performed a retrospective review of patients treated before and after protocol implementation at a university teaching hospital. A total of 256 adult patients met the criteria for diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS) and were treated with an insulin infusion between February 2011 and February 2012 (nonprotocol n = 143, protocol n = 113)...
November 2013: Endocrine Practice
Chien-Cheng Huang, Shu-Chun Kuo, Tsair-Wei Chien, Hung-Jung Lin, How-Ran Guo, Wei-Lung Chen, Jiann-Hwa Chen, Su-Hen Chang, Shih-Bin Su
BACKGROUND: We investigated independent mortality predictors of hyperglycemic crises and developed a prediction rule for emergency and critical care physicians to classify patients into mortality risk and disposition groups. METHODS: This study was done in a university-affiliated medical center. Consecutive adult patients (> 18 years old) visiting the emergency department (ED) between January 2004 and December 2010 were enrolled when they met the criteria of a hyperglycemic crisis...
May 2013: American Journal of Emergency Medicine
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