Hypoglycemic Coma Research Articles

Percutaneous Transluminal Angioplasty Alleviate Pediatric Postthrombotic Syndrome: A Case Report and Literature Review.

Postthrombotic syndrome (PTS) is one of the long-term sequelae of deep vein thrombosis (DVT), and effective symptom management in pediatric PTS remains a challenge, with interventional therapy rarely explored in this population. We present a successful case of interventional treatment pediatric PTS, resulting in a remarkable amelioration of her symptoms. This case features a 6-year-old girl diagnosed with hyperinsulinemia, leading to a hypoglycemic coma. Following a mini-pancreatic partial pancreatectomy, she required further intensive care in the pediatric intensive care unit. It was during this period that left lower extremity DVT was identified, prompting warfarin anticoagulation therapy. During the anticoagulation period, she had several bleeding events and was switched to anticoagulation with low molecular heparin. One month later, the left common iliac vein and external iliac vein was found to be completely occluded. Over time, she experienced a gradual onset of lower limb swelling and pain, which, after 6 months, was accompanied by perineal edema and venous claudication. As a result, she underwent successful percutaneous transluminal angioplasty. In addition, the anticoagulation regimen was adjusted to rivaroxaban. At the 8-month follow-up, we observed significantly improvement in her postoperative lower extremity swelling and symptoms related to venous occlusion had completely disappeared. Moreover, vascular imaging confirmed improvement in stenosis and uninterrupted blood flow. In our review of pediatric PTS studies, we observed limited options to alleviate symptoms, and interventional treatments have not been reported. Our case study, demonstrating the safe and effective use of percutaneous transluminal angioplasty, helps to illuminate this area and alleviate pediatric PTS symptoms. This case validates the efficacy and safety of using percutaneous transluminal angioplasty (PTA) for the treatment of postthrombotic syndrome (PTS) in pediatric patients. This interventional approach offers significant symptomatic relief and improves quality of life, especially in cases where traditional anticoagulation therapies fail or lead to complications. The successful case presented emphasizes the necessity of considering endovascular interventions for children with moderate to severe PTS, particularly when conservative management is ineffective. This research underscores the potential for PTA to be adopted in clinical practice, offering a promising new approach for managing pediatric PTS.

Intentional Insulin Overdose and Depression in Subjects with and Without Diabetes Mellitus: A Commentary.

Insulin is an essential medication for people with type 1 diabetes mellitus and for some people with type 2 diabetes. Interestingly, insulin abuse has been reported as a mode of suicide, not only among people with diabetes, but also among their relatives, and among medical and paramedical personnel who have access to insulin. The aim of the present commentary was to raise awareness of potential depression-related intentional insulin overdose and its complications, as well as of the diagnosis and treatment of this entity. Insulin overdose may lead to severe and prolonged hypoglycemia, hypoglycemic coma, and death. Moreover, hypokalemia, hypomagnesemia, hypophosphatemia, and elevated liver enzymes are common. Insulin overdose should be suspected among people with diabetes in case of unexplained prolonged hypoglycemia and among people without diabetes who exhibit hypoglycemia and may have access to diabetic medications. The ratio of insulin to C-peptide helps distinguish exogenous insulin administration from endogenous secretion. The cornerstone of therapy is prompt administration of concentrated glucose infusions for days with simultaneous oral intake, when possible, and intense glucose monitoring to prevent hypoglycemia. Moreover, monitoring of serum electrolyte levels is recommended. Finally, psychiatric evaluation aiming at early identification of depression and suicidality is of paramount importance.

Obtaining a mouse model of streptozotocininduced type 1 diabetes mellitus

Objective: to obtain a stable mouse model of type 1 diabetes mellitus (T1DM) using streptozotocin (STZ), which has a toxic effect on pancreatic beta cells.Materials and methods. Experiments were performed on 30 white non-diabetic male mice of the SHK colony, which were injected intraperitoneally with STZ at a dose of 200 mg/ kg by two methods: 15 animals (group 1) once and 15 animals (group 2) intermittently – 5 consecutive days at 40 mg/kg per day.Results. In group 1, one mouse died after 2 days due to hypoglycemic coma, 4 mice developed hyperosmolar hyperglycemia (>33.3 mmol/l), 3 mice had spontaneous remission of diabetes, and 7 mice had stabilized hyperglycemia at levels close to 20 mmol/l. In group 2, only one mouse showed spontaneous remission of diabetes, while the remaining 14 animals showed stable diabetes with average hyperglycemia levels moderately above 20 mmol/L until the end of the 4-week follow-up. A histological study of the pancreas of these animals confirmed the destructive effect of STZ on islets in the form of mass death of insulin-producing β-cells.Conclusion. Split-dose intraperitoneal injection of STZ provides a stable experimental T1DM in 93% of laboratory mice.

Peptide Receptor Radionuclide Therapy Is Effective for Clinical Control of Symptomatic Metastatic Insulinoma: A Long-Term Retrospective Analysis.

Metastatic insulinoma is a rare malignant neuroendocrine tumor characterized by inappropriate insulin secretion, resulting in life-threatening hypoglycemia, which is often difficult to treat. There is currently very limited information about the efficacy of peptide receptor radionuclide therapy (PRRT) for clinical control of hypoglycemia. The aim of this long-term retrospective study was to evaluate the therapeutic efficacy of PRRT for improving hypoglycemia, to evaluate the change of medication after PRRT, and to calculate progression-free survival (PFS) and overall survival (OS). Methods: Inclusion criteria were histologically proven somatostatin receptor-positive metastatic malignant insulinoma and at least 2 cycles of [90Y]Y-DOTATOC or [177Lu]Lu-DOTATOC therapy from early 2000 to early 2022. A semiquantitative scoring system was used to quantify the severity and frequency of hypoglycemic episodes under background antihypoglycemic therapy (somatostatin analog, diazoxide, everolimus, corticosteroids): score 0, no hypoglycemic episodes; score 1, hypoglycemic events requiring additional conservative treatment with optimization of nutrition; score 2, severe hypoglycemia necessitating hospitalization and combined medication or history of hypoglycemic coma. Hypoglycemic score before and after PRRT was analyzed. Time of benefit was defined as a time range of fewer hypoglycemic episodes in the observation period than at baseline. Information on antihypoglycemic medication before and after therapy, PFS, and OS was recorded. Results: Twenty-six of 32 patients with a total of 106 [90Y]Y-DOTATOC/[177Lu]Lu-DOTATOC cycles were included. The average observation period was 21.5 mo (range, 2.3-107.4 mo). Before therapy, 81% (n = 21) of the patients had a hypoglycemia score of 2 and 19% (n = 5) had a score of 1. After PRRT, 81% of patients (n = 21) had a decreased score, and the remaining 5 patients showed a stable situation. There was temporary worsening of hypoglycemia just after injection of [90Y]Y-DOTATOC/[177Lu]Lu-DOTATOC in 19% of patients. The average time of benefit in the observation period was 17.2 mo (range, 0-70.2 mo). Antihypoglycemic medication reduction was achieved in 58% (n = 15) of patients. The median OS and PFS after the start of PRRT were 19.7 mo (95% CI, 6.5-32.9 mo) and 11.7 mo (95% CI, 4.9-18.5 mo), respectively. Conclusion: To our knowledge, our study included the largest cohort of patients with malignant insulinoma to be evaluated. Long-lasting symptom control and reduction of antihypoglycemic medications were shown in most patients after late-line PRRT.

SAT141 A Case Of Non-islet Cell Tumor Hypoglycemia Which Was Ameliorated By Pazopanib Treatment

Abstract Disclosure: N. Yamamoto: None. M. Yamamoto: None. N. Kiyota: None. Y. Inaba: None. K. Kanie: None. S. Urai: None. M. Suzuki: None. Y. Sasaki: None. Y. Oi: None. Y. Tsujimoto: None. Y. Motomura: None. Y. Ohmachi: None. H. Bando: None. G. Iguchi: None. M. Nagao: None. I. Fukuda: None. H. Fukuoka: None. W. Ogawa: None. Introduction: Non-islet cell tumor hypoglycemia (NICTH) is a rare paraneoplastic syndrome caused by insulin-like growth factor II (IGF-II) hypersecretion from the tumors. It is characterized by incompletely processed big IGF-II with potent insulin-like activity. We present a case of NICTH complicated with solitary fibrous tumor (SFT) which was ameliorated with the administration of pazopanib, a multi-targeted tyrosine kinase inhibitor. Clinical Case: A 57-year-old man went into a coma and was hospitalized. His plasma glucose levels were 26 mg/dL, and he regained consciousness after glucose administration, leading to a diagnosis of hypoglycemic coma. Moreover, a contrast-enhanced CT scan showed multiple tumors in his liver and right kidney. He was referred to our hospital for further management. After 5 hours of fasting, he had a cold sweat, and his plasma glucose levels dropped to 32 mg/dL with suppressed serum insulin levels of 0.2 U/mL. Serum 3-hydroxybutyrate levels were as low as 21 μmol/L, and plasma glucose levels increased to 83 mg/dL after glucagon administration, suggesting an agent mimicking insulin. Percutaneous liver biopsy was performed, and the tumors were diagnosed with SFT. Immunoblotting for his serum showed big IGF-II, leading to a diagnosis of NICTH, and hypoglycemia due to hypersecretion of IGF-II. Due to multiple metastases, surgery was not indicated and pazopanib was administered. Hypoglycemia during the night was prevented by glucose infusion through the central venous port, and he was discharged. Three months later, when he was re-hospitalized for thrombophlebitis of the right jugular vein, hypoglycemia did not occur even after 10 hours of fasting and CT scan showed the necrotic change of the tumor. Two weeks later of pazopanib discontinuation due to the thrombogenic adverse effect, hypoglycemia recurred accompanied by the tumor enlargement. When the anticoagulation therapy regressed the thrombosis and pazopanib was re-administered, hypoglycemia improved reproducibly and remained stable for more than 2 years although the tumor showed gradual progression. Conclusion: This is the first case in which pazopanib was effective in suppressing NICTH associated with SFT. Presentation: Saturday, June 17, 2023

Segmental Humeral Head Reconstruction in Patients with Chronic Locked Posterior Shoulder Dislocation.

Background and Objectives: The goal of this study was to evaluate the functional outcomes of patient treatment using an allograft after chronic locked posterior shoulder dislocation associated with a bony defect of the upper edge of the humerus that involves 25-50% of the articular surfaces. Materials and Methods: A total of 20 patients were included in this study. Electrocution was the cause of injury in eight patients; in ten patients, the cause was direct trauma; and in two patients, the cause of injury was a fall due to hypoglycemic coma. A standard deltoid pectoral approach was used and a fresh-frozen osteochondral allograft of the femoral condyle was applied. In evaluating the results, Constant's scoring scale was used. Results: The average value of Constant's point scale for the operated shoulder is 84.14 points. This result is good according to the average value of Constant's point scale. Conclusions: Patients with locked chronic posterior dislocation in combination with a bony defect of the humeral head that covers 25-50% of the articular surface, in our opinion, should be treated using bone allografts rather than non-anatomical reconstruction methods.

Unmasked insulinoma occasioned by severe hypoglycemic coma immediately postpartum: a case report

BackgroundInsulinoma in women during pregnancy and postpartum is very rare; approximately 65% of cases are diagnosed early in pregnancy and ~ 35% immediately after delivery, few being found in middle or late pregnancy, likely due to increased insulin resistance seen after early-stage pregnancy. We successfully treated a case of insulinoma in which severe hypoglycemic coma immediately after delivery occasioned detailed investigation and diagnosis.Case presentationOur patient experienced hypoglycemic coma in the 3rd month of pregnancy (initially considered due to her hyperemesis gravidarum) that improved spontaneously during the gestational period. No abnormalities of plasma glucose or body weight were found in regular checkups during her pregnancy; however, recurrence of hypoglycemic coma after delivery led us to suspect insulinoma. While contrast enhanced computer tomography and endoscopic ultrasonography (EUS) initially failed to detect a tumor in the pancreas, selective arterial calcium stimulation test revealed an insulin-secreting tumor localized in the pancreatic body. She then underwent spleen-preserving distal pancreatectomy; a 10-mm tumor positive for chromogranin A, synaptophysin and insulin was identified.ConclusionsAlthough pregnancy can mask insulinoma-associated symptoms and make diagnosis challenging, hypoglycemic episodes during early pregnancy, which were observed in this case, are suggestive of insulinoma. Importantly, in this case, accurate preoperative localization of the tumor enabled prompt curative surgery after delivery. Thus, clinical vigilance for the occurrence of insulinoma and its localization is appropriate for pregnant women suffering severe hypoglycemia.

ACUTE FATTY LIVER OF PREGNANCY: CLINICAL FEATURES AND TREATMENT STRATEGIES IN A SINGLE-CENTER STUDY

Acute Fatty Liver of Pregnancy (AFLP) is a rare but life-threatening complication of pregnancy that typically occurs in the third trimester. This study aimed to investigate the clinical and demographic features of patients with AFLP and evaluate the effectiveness of various treatment strategies. A total of five patients were diagnosed with AFLP between January 2020 and December 2022. The mean age of the patients was 28 years, with two patients having a history of diabetes, and two patients were COVID-19 positive. The mean gestational age at diagnosis was 31 weeks and 1 day, with two patients admitted for high blood pressure, one for sudden onset jaundice, and two for delivery. All patients met the Swansea criteria for AFLP diagnosis. Three patients developed neurological symptoms in the postpartum period, two with hypoglycemic coma due to liver failure and one with hepatic encephalopathy. Two patients had renal insufficiency, one with a hemorrhagic syndrome, and one with disseminated intravascular coagulation (DIC). All patients had thrombocytopenia, and two patients had a platelet count below 50,000. Obstetric ultrasound/doppler showed an evolving monofetal pregnancy in four cases and fetal demise in one case. Two patients were treated with therapeutic plasma exchange, and two underwent continuous renal replacement therapy until renal function normalized. The patient with a hemorrhagic syndrome received two units of platelets postpartum, while the patient with DIC received fresh frozen plasma. One patient had a vaginal delivery, while four patients had a cesarean section.

Identification of predictive factors of diabetic ketoacidosis in type 1 diabetes using a subgroup discovery algorithm.

To identify predictive factors for diabetic ketoacidosis (DKA) by retrospective analysis of registry data and the use of a subgroup discovery algorithm. Data from adults and children with type 1 diabetes and more than two diabetes-related visits were analysed from the Diabetes Prospective Follow-up Registry. Q-Finder, a supervised non-parametric proprietary subgroup discovery algorithm, was used to identify subgroups with clinical characteristics associated with increased DKA risk. DKA was defined as pH less than 7.3 during a hospitalization event. Data for 108 223 adults and children, of whom 5609 (5.2%) had DKA, were studied. Q-Finder analysis identified 11 profiles associated with an increased risk of DKA: low body mass index standard deviation score; DKA at diagnosis; age 6-10 years; age 11-15 years; an HbA1cof 8.87% or higher (≥ 73 mmol/mol); no fast-acting insulin intake; age younger than 15 years and not using a continuous glucose monitoring system; physician diagnosis of nephrotic kidney disease; severe hypoglycaemia; hypoglycaemic coma; and autoimmune thyroiditis. Risk of DKA increased with the number of risk profiles matching patients' characteristics. Q-Finder confirmed common risk profiles identified by conventional statistical methods and allowed the generation of new profiles that may help predict patients with type 1 diabetes who are at a greater risk of experiencing DKA.

Metabolic control during the first two years of the COVID-19 pandemic in pediatric patients with type 1 diabetes: results from the German DPV initiative

AimTo assess effects of the SARS-CoV2 pandemic on metabolic control in youth with type 1 diabetes (T1D) in Germany in a population-based analysis.MethodsData from 33,372 pediatric T1D patients from the Diabetes Prospective Follow-up (DPV) registry, with face-to-face visits or telemedicine contacts in the years 2019–2021, were available. Datasets from eight time periods between March 15, 2020, and December 31, 2021, according to SARS-CoV2 incidence waves, were compared to those from five control time periods. Parameters of metabolic control were assessed with adjustment for sex, age, diabetes duration, and repeated measurements. Laboratory-measured HbA1c values and those estimated from CGM were aggregated into a combined glucose indicator (CGI).ResultsThere was no clinically relevant difference in metabolic control between pandemic and control time periods with adjusted CGI values ranging from 7.61% [7.60–7.63] (mean [95% confidence interval (CI)]) in the third quarter of 2019 to 7.83% [7.82–7.85] in the time period from January 1 to March 15 2020, in the other control periods, and during the pandemic, CGI values lay between these values. BMI-SDS rose during the pandemic from 0.29 [0.28–0.30] (mean [95% CI]) in the third quarter of 2019 to 0.40 [0.39–0.41] during the fourth wave. Adjusted insulin dose rose during the pandemic. Event rates for hypoglycemic coma and diabetic ketoacidosis remained unchanged.ConclusionsWe found no clinically relevant change of glycemic control or incidence of acute diabetes complications during the pandemic. The observed BMI increase may represent an important health risk for youth with T1D.

Prevalence of D.M among medical students in Mu’tah university, Al- Karak, Jordan

Diabetes mellitus is a rapidly growing health concern and it was the 9th leading cause of death worldwide in 2019. Jordan has a relatively high prevalence of diabetes mellitus (DM), and several national population-based epidemiological surveys have been conducted suggesting the rapidly growing prevalence of DM in Jordan. This study was conducted to determine the prevalence of diabetes mellitus among medical students at Mutah school of medicine in Al-Karak in Jordan. A total of 350 medical students were enrolled in this observational study. The prevalence of diabetes mellitus proved to be 2.3 % (7 students) of participants (14.3% females and 85.7% males, p=0.002). About 85.7% of diabetic student (57.1% type1 and 42.4% type2) and 45.5% of the non-diabetic students show a family history of DM. The present study shows that 34.5% of the students have an over body mass index, 2.0% of them were diabetics. (P = 0, 04). hence there is no significant relationship between BMI and DM. It was found that 28.6% of diabetic students having HbA1c (7-10 gm %) with a p value =0,001. Moreover, it was found that 50% of diabetic students have skin rash, hypertension and eye complications. Also, there is a history of hyperglycemic coma was reported in 14.3% of diabetic students and hypoglycemic coma 14.3% of diabetic students.

From dementia to delirium: The role of infections in cognitive decline – A case report

Delirium is an acute confusional state characterized by inattention, cognitive impairment and an altered level of consciousness, often precipitated by infections or surgery. In contrast, dementia manifests as a gradual, chronic and progressive decline in cognitive function that was previously acquired. Delirium superposed on dementia is a prevalent condition in older adults, representing a significant diagnostic challenge for clinicians due to the lack of tools specifically designed for its detection. Early detection and effective management are essential for minimizing associated morbidity, mortality and distress for patients and their caregivers. We present the case of a 70-year-old woman admitted to a psychiatric ward for an acute onset of persecutory delusions and visual hallucinations. Upon the third day of admission, the patient presented difficulty breathing, drowsiness, impaired response to verbal and painful stimuli, oxygen saturation of 81% and elevated blood pressure measuring 210/120 mmHg. Following the presented symptomatology, the patient was transferred to an infectious disease hospital for left lower lobe pneumonia. Ten days after being discharged, she was readmitted to the emergency department in a hypoglycemic coma and diagnosed with a urinary infection caused by Klebsiella pneumoniae. During her hospitalization, she presented typical symptoms of delirium and reported experiencing retrograde amnesia related to the episode of confusion.

Five critically ill pregnant women/parturients treated with extracorporeal membrane oxygenation

BackgroundMaternal mortality has always been a major medical concern. Recently, the successful application of extracorporeal membrane oxygenation (ECMO) technology in the rescue of near-death patients has been reported.Case presentationThis study retrospectively analyzed 5 cases of critically ill pregnant women/parturients treated with ECMO for respiratory and circulatory failure in the Wuxi People’s Hospital from 2018 to 2020. The mean age of the 5 cases was 30.2 years. Among them, Cases 1 and 5 were treated with Venoarterial (VA) ECMO. Case 1 was diagnosed with congenital heart disease, atrial septal defect, and severe pulmonary hypertension. VA ECMO was applied before cesarean section and was successfully removed after double lung transplantation, but the patient died 10 months after delivery from lung infection. While Case 5 was diagnosed with systemic lupus erythematosus, lupus nephritis, thrombotic vascular disease, HELLP syndrome, and cerebral hemorrhage. VA ECMO was applied 39 days after cesarean section, and the patient died 40 days after delivery due to multiple organ failure. Cases 3 and 4 were treated with Venovenous (VV) ECMO. Case 3 was diagnosed with refractory postpartum hemorrhage, and Case 4 was diagnosed with postpartum hypoglycemic coma, aspiration pneumonia, and shock. They were treated with VV ECMO after delivery, and all survived after successful evacuation. Another Case (Case 2) was diagnosed with postpartum pelvic infection, sepsis and septic shock, and was treated with VA ECMO at 15 days after delivery. The patient changed to VV ECMO at 30 days after delivery due to significant improvement in heart function and poor lung function, but eventually died of multiple organ failure. For the 5 cases, the mean duration of ECMO was 8.7 days, the mean duration of intensive care was 22.0 days, and the mean length of hospital stay was 57.6 days. As a result, 3 patients gradually returned to normal with significant improvement in ventilation and oxygenation after ECMO treatment.ConclusionsECMO technology can be used to treat some of the critical obstetric patients with respiratory and circulatory failure that is ineffective to conventional treatment, but it has no therapeutic effect on the primary disease.

Structure of mortality among patients with diabetes mellitus in the republic of Uzbekistan during COVID-19 pandemia

BACKGROUND. The COVID-19 pandemic has caused enormous damage to all countries of the world. Patients with diabetes mellitus are a separate risk group for the consequences of COVID-19, both in the acute and in the long-term period.AIM. To study change in the structure of mortality among patients with diabetes in the Republic of Uzbekistan during the COVID-19 pandemic.MATERIALS AND METHODS. We analyzed the data of the report forms of endocrinological dispensaries for reasons of deaths registered among patients with 2 diabetes mellitus in 2020 and compared these indicators with the data of 2019.RESULTS. In 2020, mortality among patients with diabetes increased 1.5 times compared to 2019 and was 4.3% (compared to 2.8% in 2019). Among the causes of deaths, cardiovascular accidents prevailed: 57,9% in 2020 (48,0% in 2019), cerebrovascular accidents (15,6% in 2020 and 24,2% in 2019), chronic kidney disease (12,0% and 15,1%), gangrene, sepsis (1,2% and 1,8%), the frequency of hyper- and hypoglycemic comas as causes of death was 0.6% both in 2019 and in 2020, however, the absolute number increased in 2020. Among the «other» causes of death (12.8% in 2020 and 10,2% in 2019), COVID-19 itself was 52,3%, pneumonia 17,2%, pulmonary embolism 1%, oncological diseases 12%, liver cirrhosis 12%.CONCLUSIONS. Despite the fact that COVID-19 caused deaths in 6.7% of patients with diabetes, the COVID-19 pandemic caused a significant increase in mortality — 1.5 times — among patients with diabetes, mainly due to acute cardiovascular accidents, stroke, as well as accelerating the progression of chronic complications of diabetes, in particular chronic kidney disease.

A comparison of the rapid-acting insulin analogue glulisine with lispro and aspart for the pump treatment of patients with type 1 diabetes.

(1) To describe the population of patients with type 1 diabetes (T1DM) using the rapid-acting insulin analogue glulisine versus lispro and aspart during continuous subcutaneous insulin infusion (CSII); (2) to describe insulin relative effectiveness based on hemoglobin A1c (HbA1c), fasting blood glucose (FBG) and dose; (3) to determine rates of hyperglycemia, hypoglycemia, and diabetic ketoacidosis (DKA). The analysis used March 2021 data from the Diabetes-Patienten-Verlaufsdokumentation registry, which contains data of 618,903 patients with diabetes. Patients were propensity-matched by age, sex, and diabetes duration. Overall, 42,736 patients of any age were eligible for analysis based on insulin pump usage with either glulisine (N = 707) or lispro/aspart (N = 42,029) between 2004 and 2020. Patients receiving glulisine were older (median 20.0 vs. 16.2years), equally often male (47.2% vs. 47.8%) and had a longer diabetes duration (median 9.4 vs. 7.4years). After propensity score matching, 707 pairs remained (total N = 1414). Patient characteristics between groups were similar. Achieved HbA1c values were also comparable: 8.04%, 64mmol/mol versus 7.96%, 63mmol/mol for glulisine and lispro/aspart [LS mean difference 0.08 (95%CI -0.08, 0.25)]. FBG was 9.37mmol/L (168.9mg/dL) and 9.58mmol/L (172.6mg/dL) in the glulisine and lispro/aspart groups [LS mean diff. -0.21; (95%CI -1.13, 0.72)]. Total daily insulin doses and prandial to total insulin ratios were also similar. Glulisine group patients had higher rates of lipodystrophy (0.85% vs. 0.71%) (LS mean diff. 0.18 [95% CI -1.01, 1.38]) and non-severe DKA (3.11% vs. 0.57%; p = 0.002). Fewer patients in the glulisine group had severe hypoglycemic events (7.66 vs. 9.09; p = 0.333) and severe ketoacidosis events (0.57% vs. 1.56%; p = 0.082) but more had hypoglycemic coma events (p = 0.773), although the differences were not statistically significant. Insulin glulisine had comparable glucose control to lispro/aspart. The use of glulisine was less frequent in the present analysis compared to the previous trials.

CLINICAL PROFILE OF PATIENTS WITH DIABETIC COMA IN DR. SOETOMO STATE/TEACHING HOSPITAL IN YEAR 2013-2016

Background: The known conditions of diabetes which may cause coma are diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar state (HHS) and hypoglycemia (Shah and Joshi, 2004). This diabetic coma can be an emergency case within three hours if not resolved (Shah and Joshi, 2004). Objective: This study aims to study the profile of diabetic coma sufferers in order to improve the understanding of diabetic coma and thus improves services for patients. Method: This was a retrospective study by assessing patients’ medical record and analyzed descriptively. Result: The results obtained from 80 patients with the majority of women (62%). Diabetic coma attacks mostly at the age of 50-59 years (36%). Based on historical data, the major complaints were consciousness disturbance (31%) and loss of consciousness (31%). Patient's blood pressure results mostly (30%) was noted to show that patients suffer from first-stage hypertension, whereas on other physical examinations such as pulse and body temperature, generally obtained normal results with a percentage of 80% and 56% respectively. Respiration rate for hypoglycemic patients are mostly normal, but 97% of hyperglycemic crisis patients present high rate of respiration. In blood tests, the hemoglobin and platelet counts were predominantly normal, with percentages of 61%, and 58%, respectively, but the leukocyte levels of patients mostly were abnormally high (64%). Examination of patient’s renal function in patients with post hypoglycemic coma shows that majority of patients get normal results, 62% of normal creatinin serum and 67% of normal BUN. In the other hand, for patients with hyperglycemic crisis, mostly shows an elevated creatinin serum and BUN, 79% and 86% each. The patient's body ion levels recorded were sodium and potassium levels, both of which were predominantly classified as normal, 49% and 51% respectively. With random blood sugar test, 37 patients (55%) with hypoglycemia showed abnormally low blood sugar outcomes, but 86% of patients with hyperglycemic crisis showed abnormally high blood sugar. Examination of blood gas analyzes records the values of blood acidity, partial pressure of oxygen and carbon dioxide, HCO3- level, base excess, and oxygen saturation. Results show a predominantly abnormal results (abnormally high for partial oxygen pressure but abnormally low for blood acidity, partial pressures of carbon dioxide, HCO3-, and base excesses). Examination of albumin content, 53% showed normal results. Most results of thorax photo (22%) showed no abnormality. With proper treatment, the majority of patients with hypoglycemia went home with improved condition, whereas most patients with hyperglycemic crisis died even after given treatments.

Glycogen Storage Disease Type IXb in a Neonate Caused by Two Mutations in PHKB Gene

Glycogen storage disease (GSD) is rare to present in the neonatal period. We present a neonate with hypoglycemic coma, diagnosed as GSD IXb by whole-exome sequencing. The neonate improved with supportive care. We identified 2 variants in exon 22 and exon 24 of the PHKB gene located on chromosome 16q12.1 in a neonate whose parents were also found to carry these variants was detected by Sanger sequencing.

Neurological Prognostication After Hypoglycemic Coma: Role of Clinical and EEG Findings.

Hypoglycemic coma (HC) is an uncommon but severe clinical condition associated with poor neurological outcome. There is a dearth of robust neurological prognostic factors after HC. On the other hand, there is an increasing body of literature on reliable prognostic markers in the postanoxic coma, a similar-albeit not identical-situation. The objective of this study was thus to investigate the use and predictive value of these markers in HC. We conducted a retrospective, multicenter, cohort study within five centers of the Critical Care EEG Monitoring Research Consortium. We queried our electroencephalography (EEG) databases to identify all patients undergoing continuous EEG monitoring after admission to an intensive care unit with HC (defined as Glasgow Coma Scale < 8 on admission and a first blood glucose level < 50mg/dL or not documented but in an obvious clinical context) between 01/01/2010 and 12/31/2020. We studied the association of findings at neurological examination (Glasgow Coma Scale motor subscale, pupillary light and corneal reflexes) and at continuous EEG monitoring(highly malignant patterns, reactivity, periodic discharges, seizures) with best neurological outcome within 3months after hospital discharge, defined by the Cerebral Performance Category as favorable (1-3: recovery of consciousness) versus unfavorable (4-5: lack of recovery of consciousness). We identified 60 patients (30 [50%] women; age 62 [51-72] years). Thirty-one and 29 patients had a favorable and unfavorable outcome, respectively. The presence of pupillary reflexes (24 [100%] vs. 17 [81%]; p value 0.04) and a motor subscore > 2 (22 [92%] vs. 12 [63%]; p value 0.03) at 48-72h were associated with a favorable outcome. A highly malignant EEG pattern was observed in 7 of 29 (24%) patients with unfavorable outcome versus 0 of 31 (0%) with favorable outcome, whereas the presence of EEG reactivity was observed in 28 of 31 (90%) patients with favorable outcome versus 13 of 29 (45%) with unfavorable outcome (p < 0.001 for comparison of all background categories). This preliminary study suggests that highly malignant EEG patterns might be reliable prognostic markers of unfavorable outcome after HC. Other EEG findings, including lack of EEG reactivity and seizures and clinical findings appear less accurate. These findings should be replicated in a larger multicenter prospective study.

IDF21-0090 Structure of mortality among patients with diabetes mellitus in the republic of Uzbekistan during COVID-19 pandemia

Background: The COVID-19 pandemic has caused enormous damage to all countries of the world. Patients with diabetes mellitus are a separate risk group for the consequences of COVID-19, both in the acute and in the long-term period. Aim: To study change in the structure of mortality among patients with diabetes in the Republic of Uzbekistan during the COVID-19 pandemic. Method: We analyzed the data of the report forms of endocrinological dispensaries for reasons of deaths registered among patients with type 2 diabetes mellitus in 2020 and compared these indicators with the data of 2019. Results: In 2020, mortality among patients with diabetes increased 1.5 times compared to 2019 and was 4.3% (compared to 2.8% in 2019). Among the causes of deaths, cardiovascular accidents prevailed: 57.9% in 2020 (48.0% in 2019), cerebrovascular accidents (15.6% in 2020 and 24.2% in 2019), chronic kidney disease (12.0% and 15.1%), gangrene, sepsis (1.2% and 1.8%), the frequency of hyper- and hypoglycemic comas as causes of death was 0.4% and 0.2%, respectively, both in 2019 and in 2020, however, the absolute number increased in 2020. Among the “other” causes of death (12.8% in 2020 and 10.2% in 2019), COVID-19 itself was 53%, pneumonia 17%, pulmonary embolism 1%, oncological diseases 12%, liver cirrhosis 12%. Discussion: Despite the fact that COVID-19 caused deaths in 2.9% of patients with diabetes, the COVID-19 pandemic caused a significant increase in mortality - 1.5 times - among patients with diabetes, mainly due to acute cardiovascular accidents, stroke, as well as accelerating the progression of chronic complications of diabetes, in particular chronic kidney disease.

A case of successful treatment of twelve-day hypoglycemic coma

The development of hypoglycemic coma is a severe complication of insulin therapy for diabetes mellitus. According to the literature, being in a hypoglycemic coma for more than 12 hours is associated with a threat to life due to the development of decortication and leads to high mortality. Most often, hypoglycemic coma occurs as a result of the administration of insulin in combination with the intake of large amounts of alcohol against the background of insufficient food intake. The patient's condition in connection with the intake of alcohol is underestimated by others, which leads to late hospitalization and, accordingly, to severe outcomes.