Hyperosmolar Hyperglycemic State Research Articles

The association between heat exposure and hospitalization for diabetic ketoacidosis, hyperosmolar hyperglycemic state, and hypoglycemia. a scoping review

The association between heat exposure and hospitalization for diabetic ketoacidosis, hyperosmolar hyperglycemic state, and hypoglycemia. a scoping review

Understanding the Complexity of Hyperglycemic Emergencies: Exploring the Influence of the Type and Duration of Diabetes Mellitus and Its Impact on Mortality.

Background Diabetes mellitus remains a pressing global health issue, characterized by chronic metabolic dysfunction and the potential for life-threatening acute hyperglycemic emergencies. These emergencies, known as diabetic ketoacidosis and hyperosmolar hyperglycemic states, trigger a series of physiological disruptions. This article delves deeply into how the type and duration of diabetes mellitus affect the occurrence of hyperglycemic emergencies and mortality rates. Methods The study was conducted at the Institute of Internal Medicine, Rajiv Gandhi General Hospital, affiliated with Madras Medical College, spanning from July 2021 to December 2021. It encompassed both individuals newly diagnosed with diabetic ketoacidosis and patients already undergoing diabetic treatment who developed diabetic ketoacidosis and hyperosmolar hyperglycemic states. Results Within the study cohort of 110 patients, 37.27% were diagnosed with Type 1 diabetes mellitus, while 62.73% were classified as Type 2 diabetes mellitus patients. Among these individuals, 23.60% were newly diagnosed with diabetes, 22.70% had been diabetic for less than one year, 47.30% had a diabetic history of two to five years, and 6.40% had been diabetic for over six years. However, upon investigating the relationship between diabetes duration and mortality rate, no statistically significant findings were observed. Conclusion Hyperglycemic emergencies represent multifaceted clinical challenges influenced by the interplay of various factors, including the type and duration of the disease. By maintaining effective management of hyperglycemia from the outset and sustaining it throughout their lives, people with diabetes can improve their physical and mental health and reduce the likelihood of developing long-term complications that may negatively impact their overall well-being.

Hypoglycemia during hyperosmolar hyperglycemic crises is associated with long-term mortality

BackgroundPrevious research has indicated that hypoglycemia during hospitalization is a predictor of unfavorable outcomes in patients with diabetes. However, no studies have examined the long-term impact of hypoglycemia in adults admitted for hyperglycemic crises. The study was aimed to investigate the long-term implications of hypoglycemia during hyperosmolar hyperglycemic crises, particularly in terms of all-cause mortality.MethodsThis retrospective cohort study included 170 patients (82 men [48.2%], median age 72 years) admitted to a university hospital for hyperosmolar hyperglycemic crises, including pure hyperosmolar hyperglycemic states and hyperosmolar diabetic ketoacidoses. We separately investigated the prognostic significance of hypoglycemia on mortality during the initial intravenous insulin therapy phase and during the later subcutaneous insulin therapy phase, both during hospitalization and in the long term (median follow-up, 652 days; range 2–3460 days).ResultsBoth hypoglycemia during the initial intravenous insulin therapy phase (observed in 26.5% of patients) and hypoglycemia during the later subcutaneous insulin therapy phase (observed in 52.7% of patients) were associated with long-term mortality. After adjusting for potential confounders, hypoglycemia during the initial intravenous insulin therapy phase remained associated with mortality (hazard ratio 2.10, 95% CI 1.27–3.46, p = 0.004).ConclusionsHypoglycemia during hyperosmolar hyperglycemic crises is a marker of long-term mortality, especially when it occurs during the initial intravenous insulin therapy phase.

Inflammatory biomarkers predict higher risk of hyperglycemic crises but not outcomes in diabetic patients with COVID-19.

Inflammation is a predictor of severe complications in patients with COVID-19 infection under a variety of clinical settings. A few studies suggested that COVID-19 infection was a trigger of hyperglycemic crises including diabetic ketoacidosis (DKA) and/or hyperglycemic hyperosmolar state (HHS). However, the association between inflammation and hyperglycemic crises in diabetic patients with COVID-19 infection is unclear. One hundred and twenty-four patients with type 2 diabetes mellitus (T2DM) and COVID-19 infection from January 2023 to March 2023 were retrospectively analyzed. Demographic, clinical, and laboratory data, especially inflammatory markers including white blood cell (WBC), neutrophils, neutrophil-to-lymphocyte ratio (NLR), c-reactive protein (CRP) and procalcitonin (PCT) were collected and compared between patients with or without DKA and/or HHS. Multivariable logistic regression analysis was conducted to explore the association between inflammatory biomarkers and the prevalence of hyperglycemic crises. Patients were followed up 6 months for outcomes. Among 124 diabetic patients with COVID-19, 9 were diagnosed with DKA or HHS. Comparing COVID-19 without acute diabetic complications (ADC), patients with DKA or HHS showed elevated levels of c-reactive protein (CRP, P=0.0312) and procalcitonin (PCT, P=0.0270). The power of CRP and PCT to discriminate DKA or HHS with the area under the receiver operating characteristics curve (AUROC) were 0.723 and 0.794, respectively. Multivariate logistic regression indicated 1.95-fold and 1.97-fold increased risk of DKA or HHS with 1-unit increment of CRP and PCT, respectively. However, neither CRP nor PCT could predict poor outcomes in diabetic patients with COVID-19. In this small sample size study, we firstly found that elevated serum CRP and PCT levels increased the risk of hyperglycemic crises in T2DM patients with COVID-19 infection. More study is needed to confirm our findings.

Psychiatric and Substance Use Disorders and Their Association With Clinical Outcomes in Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic Syndrome

BackgroundDiabetic Ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are life-threatening conditions that send nearly 180,000 patients to the ICU each year, with mortality rates up to 5-10%. Little is known about the impact of concurrent psychiatric disorders on specific DKA/HHS outcomes. Identifying these relationships offers opportunities to improve clinical management, treatment planning, and mitigate associated morbidity and mortality. MethodsWe conducted a retrospective review including adult DKA/HHS admissions within a large Massachusetts hospital system from 2010 – 2019. We identified patients admitted inpatient for DKA or HHS, then filtered by ICD-9-CM, ICD-10-CM codes for psychiatric diagnoses that were present in patients EMR at any point in this observational period. Outcomes included number of inpatient admissions for DKA/HHS, age of death, rates of discharging against medical advice (AMA) from any inpatient admission, and ESRD/dialysis status. Multivariate regression was conducted using R software to control for variables across patients and evaluate relationships between outcomes and concurrent psychiatric disorders. Significance was set at p <0.05. Results7756 patients were admitted for DKA or HHS, 66.9% of which had a concurrent psychiatric disorder. 54.5% of these patients were male, 70.4% White, and an average age of 61.6 years. This compares with 26.1% with concurrent psychiatric condition within the general diabetes population, 52.1% of which were male, 72.1% White, and an average of 68.2 years . A concurrent psychiatric disorder was associated with increased odds of rehospitalization (aOR= 1.62 95%Cl 1.35 - 1.95, p<0.001), of being diagnosed with end-stage renal disease and on dialysis (aOR = 1.02 95% Cl 1.002 – 1.035, p = 0.02), and in leaving AMA (aOR = 6.44 95%Cl 4.46 – 9.63, p <0.001). The average age of death for those with a concurrent psychiatric disorder had an adjusted mean difference in years of -7.5 years (95% Cl -9.3 5.8) compared to those without a psychiatric disorder. Conclusion66.9% of patients with DKA/HHS have a concurrent psychiatric disorder. Patients with a concurrent psychiatric disorder admitted for DKA/HHS were more likely to have multiple admissions, to leave AMA, to be on renal dialysis, and have a lower age of mortality.

The Dark side of the White Matter. Diffuse subcortical White Matter Hypointensity on T2/FLAIR: A systematic review of a frequently underrecognized sign

Background and objectivesMany reversible brain MRI abnormalities have been described, among these the most frequently reported are cortical hyperintensities on FLAIR/T2 occurring during seizures. Much less attention has been given to those situations where White Matter goes Dark: subcortical white matter hypointensity on T2/FLAIR. Our aim is to identify the medical condition “Dark White Matter” (DWM) is more frequently associated with. This is the first systematic review on DWM. MethodsPubMed was searched in August 2023. Included studies were those reporting Diffuse Subcortical White Matter Hypointensity on T2/FLAIR. Mainly case reports were included. Individual patient-level data was included whenever available. Frequency measures of the different diseases were calculated. Results56 studies were included, 228 patients were eligible for analysis. DWM happened in isolation, with no cortical abnormalities, in 71 cases and was associated with seizures in >61.4% of cases. The most frequently DWM-associated disease was Non-Ketotic Hyperglycaemic hyperosmolar state (NKH), followed by Encephalitis, Moyamoya disease, Genetic Causes, and Subdural Hematoma. Frequency of NKH was 32%. NKH was associated with seizures in 100% of cases and the most frequently involved lobe was the occipital one. When considering only the subgroup of patients with seizures, DWM was indicative of NKH in 51.4% of cases and Encephalitis in 26.4% of cases. Key limitations are heterogeneity and missing data. DiscussionDWM is frequently underdiagnosed. This sign can exist alone and it is not merely a consequence of cortical involvement. Moreover, it has important implications, both diagnostic and therapeutic, as it is more frequently associated with NKH, especially in the context of seizures, where anti-seizure medication is not the first line of treatment. We also discuss the pathogenesis of DWM by finding a common link between the most frequently associated diseases.

Spontaneous hydropneumothorax with unknown origin and new onset hyperosmolar hyperglycemic state: case report in limited health facility

Introduction: Hydropneumothorax and Hyperosmolar Hyperglycaemic State (HHS) are uncommon disorders with serious mortality. Both conditions need appropriate intervention and monitoring in comprehensive health facilities. Reports on the occurrence of spontaneous hydropneumothorax accompanied by HHS are still limited, due to the rarity of these two disorders.Case Presentation: A 42-year-old woman with abrupt shortness of breath started 1 day ago. No coughing or chest pain. Losing weight in last six months. There was no history of any disease and medication. Physical findings were drowsy consciousness with tachycardia and weak pulse, asymmetrical chest expansion with retraction, vesicular breath sounds diminished in the left lung following hyper resonant in percussion. The extremities were cold and dry. Skin turgor was reduced. Plain CXR revealed air and fluid in left pleural cavity. Laboratory test revealed very high blood glucose with hyperosmolarity.Discussion: Hydropneumothorax is the presence of air in the pleural space accompanied by ipsilateral effusion. The manifestations include shortness of breath, increased work of breathing, and sharp chest pain, or asymptomatic. It is unclear whether this patient's hyperglycaemia is related to the occurrence of spontaneous hydropneumothorax. HHS can be diagnosed by effective serum osmolality with glucose levels plus appropriate medical presentation. The management is based on the correction of dehydration, hyperglycaemia, hyperosmolarity, and precipitating conditions.Conclusion: Both hydropneumothorax and HHS have high mortality rates, particularly when the two conditions coexist. This case met some challenging issues that might increase the mortality.

Неотложная помощь при экстренных состояниях в диабетологии

Management of medical emergencies in diabetology is an essential area of interest for anesthesiology and intensive care medicine. The main complications of diabetes mellitus (DM) that require intensive treatment and pose a risk of death are hypoglycemia, diabetic ketoacidosis (DKA), and hyperosmolar hyperglycemic state (HHS). This paper provides an analysis of modern scientific publications devoted to clinical manifestations of hypoglycemia, DKA and HHS, and specific aspects of urgent care in these conditions. As demonstrated by data provided here, intensive therapy of these complications of DM is based on stabilization of blood glucose levels, administration of intravenous insulin in DKA and HHS, as well as infusion therapy and correction of electrolyte disturbances. This work discusses the main medications used for treatment of hypoglycemia, DKA and HHS, along with their dosing regimens and routes of administration. Emphasis is made on measures for prevention of cerebral edema, which the main complication associated with these conditions. Knowledge and strict adherence to therapeutic algorithms in medical emergencies in diabetology will help improve clinical outcomes, reduce the risk of complications and bring down death rates.

Managing Diabetes Mellitus in the Emergency Department.

Diabetes mellitus (DM) is a chronic medical condition that continues to increase in prevalence. Complications of DM, including diabetic ketoacidosis and hyperglycemic hyperosmolar state, often present in the emergency department requiring emergent management. Prompt assessment, diagnosis, evaluation of laboratory values, treatment, monitoring, and strict follow-up education are essential to the successful management of this complex disease. Common medications and management strategies are key elements to control DM. This article presents an overview of DM, including its prevalence, pathophysiology, presentations, and management.

Osmotic Demyelination Syndrome in a Patient with Diabetic Ketoacidosis Despite No Rapid Sodium Correction.

Osmotic demyelination syndrome (ODS) occurs in patients with diabetes and hyponatremia. We herein report a case of ODS with chorea detected on serial magnetic resonance imaging (MRI), despite no prompt hyponatremia correction. A 74-year-old man with cirrhosis and uncontrolled type 2 diabetes developed an altered mental status and chorea during treatment for diabetic ketoacidosis (DKA). Despite no rapid sodium correction and normal initial brain MRI findings, serial MRI revealed ODS-related abnormalities. Clinicians should consider ODS in patients with DKA and a hyperosmolar hyperglycemic state displaying unconsciousness and neurological manifestations, including chorea, even without substantial changes in serum sodium levels. An MRI re-examination can help capture missing ODS complications.

Complications of Diabetes Mellitus: A Review Article

Introduction: Diabetes Mellitus is a chronic disease that will be suffered for a lifetime so the progressive disease will continue and can cause complications. Diabetes mellitus usually progresses slowly with symptoms that are mild to severe and can even cause death due to acute or chronic complications.&#x0D; &#x0D; Content: Hyperglycemic crisis is one of the acute complications that can occur in Diabetes mellitus, both type 1 and type 2. This situation is a serious complication that may occur even in well-controlled diabetes mellitus.&#x0D; Conclusion: Diabetic ketoacidosis and hyperglycemic Hyperosmolar State are acute complications of Diabetes mellitus. Both of these complications can be triggered due to inadequate insulin therapy and the presence of infection. Diabetic ketoacidosis is a condition characterized by metabolic acidosis due to excessive formation of ketones, while a hyperglycemic hyperosmolar state is characterized by severe hyperosmolality with serum glucose levels which are usually higher than diabetic ketoacidosis.

Incidence and Characteristics of the Hyperosmolar Hyperglycemic State: A Danish Cohort Study.

The hyperosmolar hyperglycemic state (HHS) is a rare and life-threatening complication of diabetes. We aimed to estimate the incidence of HHS and describe the clinical and biomarker profiles of patients with HHS, including subgroups with acidosis and acute kidney injury. This nationwide, descriptive cohort study used Danish registry data during years 2016-2018 to identify acutely admitted patients fulfilling the hyperglycemia and hyperosmolarity criteria of HHS (glucose ≥33 mmol/L and osmolarity [2 × sodium + glucose] ≥320 mmol/L). We identified 634 patients (median age, 69 years (first quartile; third quartile: 58; 79) who met the criteria of HHS among 4.80 million inhabitants aged ≥18 years. The incidence rates were 16.5 and 3.9 per 10,000 person-years among people with known type 1 (n = 24,196) and type 2 (n = 251,357) diabetes, respectively. Thirty-two percent of patients with HHS were not previously diagnosed with diabetes. Patients were categorized as pure HHS (n = 394) and combined HHS and diabetic ketoacidosis (HHS-DKA; n = 240). The in-hospital mortality rate for pure HHS was 17% and 9% for HHS-DKA. The incidence of HHS was higher among patients with type 1 diabetes compared with type 2 diabetes. HHS is a spectrum of hyperglycemic crises and can be divided in pure HHS and HHS-DKA. In one-third of patients, HHS was the debut of their diabetes diagnosis.

Accuracy of Diagnosing Diabetic Ketoacidosis (DKA), Hyperosmolar Hyperglycemic State (HHS), and DKA-HHS: The Significance for Cardiac Function

BackgroundDiabetic Ketoacidosis (DKA) and Hyperosmolar Hyperglycemic State (HHS) are severe complications of diabetes. DKA is characterized by high blood glucose, low blood bicarbonate, and high BOHB, while HHS is associated with high serum osmolality. DKA-HHS is a combination of both, which can lead to a higher mortality rate due to acidosis, electrolyte imbalances, and suboptimal IVF replacement causing cardiac injury. This study aims to determine the accuracy of the initial ED diagnosis of DKA and identify patients with HHS or DKA-HHS among those initially diagnosed with DKA. MethodsIn this retrospective, single-site study, 20 adult patients who were consecutively admitted in January 2023 with a diagnosis of DKA were re-evaluated using BMP, serum osmolality, and BOHB to determine their actual diagnosis. The diagnostic error rate was calculated, and chi-square analysis was used to compare categorical variables. ResultsUpon re-evaluation of laboratory values, 15 patients (75%) were confirmed to have DKA, 4 patients (20%) had HHS, and 1 patient (5%) had DKA-HHS. The diagnostic error rate was 25% (p<0.05), with 5 of the 20 patients misdiagnosed with DKA. ConclusionThis retrospective, single-site study suggests that the ED admitting diagnosis of DKA was incorrect in 25% of 20 subjects. This finding supports the hypothesis that the ED may fail to properly diagnose HHS or DKA-HHS. Therefore, further research is necessary to evaluate the efficacy of educating diabetic patients and ED staff on DKA, HHS, and DKA-HHS diagnostic criteria in preventing misdiagnosis and cardiac injury with the ultimate goal of improving diabetic patient care.

The effectiveness of booklets on family knowledge of diabetes mellitus patients about the management of hypoglycaemia

The three main acute complications of diabetes mellitus related to an imbalance in glucose levels that lasted in the short term were hypoglycemia, diabetic ketoacidosis (DKA), and hyperglycemic hyperosmolar nonketotic syndrome. The family, as the people closest to and always interacting with the patient, played a significant role in preventing complications. A booklet served as one medium to increase knowledge for families. This study aimed to determine the effectiveness of the booklet on the knowledge of families of DM patients regarding the management of hypoglycemia. A quantitative method with a quasi-experimental design approach involving pre-test and post-test designs was employed. The population in this study comprised families of Diabetes Mellitus patients who were at Puskesmas (Public Health Centre) Batu X and Puskesmas Mekarbaru, Indonesia. The research sample consisted of 70 respondents selected through purposive sampling. The research variables included demographic factors, family knowledge before and after the intervention in the intervention and control groups, and bivariate analysis. The research instrument employed a questionnaire and a booklet regarding the management of hypoglycemia. Independent t-test analysis was conducted (α = 0.05). The booklet proved effective in improving the knowledge of families of diabetes mellitus patients regarding the management of hypoglycemia, with a p-value of 0.028. The booklet can enhance family knowledge about the management of hypoglycemia. Therefore, every internal medicine clinic or health centre should provide booklets as an educational medium.

Hyperglycaemic hyperosmolar state: No longer an endocrine crisis exclusive to adulthood.

Hyperglycaemic hyperosmolar state: No longer an endocrine crisis exclusive to adulthood.

Extreme hypernatraemia and rhabdomyolysis in a child with hyperosmolar hyperglycaemic state mixed with diabetic ketoacidosis

Abstract Diabetic ketoacidosis (DKA) is present at diagnosis for about 40% of children with type 1 diabetes mellitus (DM).1 Hyperosmolar hyperglycaemic state (HHS) is another acute complication of DM more typically associated with type 2 DM in adults or adolescents. Recent evidence indicates that a mixed picture of HHS and DKA also occurs in children with type 1 DM2 but it is not frequently reported and therefore at risk of under‐recognition.Here, we report a rare case of HHS mixed with DKA as the first presentation for type 1 DM in a five‐year‐old child with underlying neurodevelopmental problems. Failure to recognise the HHS aspects led to severe hypernatraemia, hyperosmolarity, acute renal impairment and rhabdomyolysis but ultimately the child made a full recovery. This case highlights the importance of early recognition and potential pitfalls in management of mixed HHS with type 1 DM. Copyright © 2023 John Wiley &amp; Sons.

Hyperglycaemia Among Diabetes Patients: A Preventive Approach

Hyperglycaemia is a presence of too much high glucose (sugar) in the bloodstream if it is not well-controlled. When the blood glucose level (BGL) is above 15 mmol/l, the situation is considered as hyperglycaemia. Long-term uncontrolled hyperglycaemia can affect type 1 diabetes (T1D) and type 2 diabetes (T2D) patients, as well as pregnant women with gestational diabetes. If it is not treated for a long-time, different vital organs of the body, such as the eyes, nerves, kidneys, and blood vessels may permanently damage. Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are diabetes emergencies and life-threatening complications in hyperglycaemia. Prevention and treatment of hyperglycaemia and its related complications are necessary for a healthy life of diabetes patients. This study tries to discuss the causes, symptoms, prevention, and treatment of hyperglycaemia with highlights on DKA and HHS.

An unusual case of hyperosmolar hyperglycaemic state

An unusual case of hyperosmolar hyperglycaemic state

Hyperosmolar hyperglycemic state presenting as transient global aphasia

Hyperosmolar hyperglycemic state (HHS) is an emergency condition characterized by severe dehydration secondary to uncontrolled hyperglycemic state in the absence of ketoacidosis. HHS can present with a variety of neurological symptoms including encephalopathy and seizures. In this report, we present a case of acute-onset transient global aphasia in a 65-year-old male with chronic poor glycemic control. Post-evaluation, we establish the etiology of transient global aphasia as HHS in which patient had complete recovery of symptoms following normalization of blood glucose levels.

Pyrotinib versus placebo in combination with trastuzumab and docetaxel as first line treatment in patients with HER2 positive metastatic breast cancer (PHILA): randomised, double blind, multicentre, phase 3 trial

ObjectiveTo assess the efficacy and safety of pyrotinib (an irreversible pan-HER (human epidermal growth factor receptor) inhibitor), trastuzumab, and docetaxel compared with placebo, trastuzumab, and docetaxel for untreated HER2 positive...