A Case of Diabetic Ketoacidosis Presenting with Hypernatremia, Hyperosmolarity, and Altered Sensorium

Kumar, Vinod; Nanavati, Sushant; Melki, Gabriel; Upadhyaya, Mira; Dhillon, Raman; Gibiezaite, Sandra; Michael, Patrick; Singhal, Monisha

doi:10.1155/2018/4806598

Cited by 6 publications

(5 citation statements)

References 9 publications

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“…Disturbance in osmotic can change the ions levels across the membrane. vasopressin, is an antidiuretic hormone that is a major regulator of water balance and aberrations can lead to an uncommon condition called diabetes insipidus, in which the kidneys are unable to prevent the excretion of water [24,25]. Therefore, the management hypernatremia and hyperkalemia in severe cases of diabetes are important.…”

Section: Discussionmentioning

confidence: 99%

Serum electrolytes levels in patients with type 2 diabetes mellitus: a cross-sectional study

Reshma¹,

Sushith²,

Prathima³

et al. 2020

Diabetes mellitus

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BACKGROUND:Diabetes Mellitus (DM) is a common metabolic disease worldwide. Electrolyte played significant roles in thenormal functioning of the body, and deregulation is indicative of different types of disease and electrolyte disturbances are often reported in type 2 DM (T2DM). AIM:The aim of the study was to estimate the levels of serum electrolytes in outpatients with T2DM and correlate serum electrolytes with random blood sugar (RBS). MATERIALS AND METHODS:Patients with T2DM visiting the outpatient Departments of Medicine, between April 2016 and March 2017 were included. Of 148 diagnosed T2DM cases, 74 were had RBS level 300mg/dL (group-1) and 74 had RBSlevel 300mg/dL (group-2). Serum sodium (Na+), potassium (K+), chloride (Cl-) levels were measured by using the Roche 9180electrolyte analyzer. RESULTS:In this study, there was a significant decrease in serum Na+levels in group 1 (131.834.36 mmol/L) compared to group 2(134.154.90mmol/L).The serum levels of K+was found to be increased in group 1 (4.510.61 mmol/L) in comparison with group 2 (4.260.52 mmol/L). In group-1, an inverse relationship was present between serum Na+(r=-0.342) and Cl-(r=-0.538) with RBS which was statistically significant. In group-2, a significant correlation was present between serum K+and RBS (r=0.356, p0.05). CONCLUSIONS:The study showed lower levels of Na+and higher K+levels in group-1 compared to group-2 subjects. This study showed that the distribution of serum Na+and K+levels is dependent on plasma glucose levels in patients with DM and also suggests that monitoring the electrolyte levels in hyperglycemia is pertinent in the management of diabetes.

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Section: Discussionmentioning

confidence: 99%

Serum electrolytes levels in patients with type 2 diabetes mellitus: a cross-sectional study

Reshma¹,

Sushith²,

Prathima³

et al. 2020

Diabetes mellitus

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“…Hyperkalemia was associated with hyponatremia in 3% cases found in Addison's disease with DM and with hypernatremia in 2% cases found in HHS (type 2 DM). Aldosterone deficiency causes loss of sodium and increased potassium in the blood and hyperkalemia in HHS may be due to hyperosmolar state [12,13]. Two cases of hyperkalemia associated with PCOS were due to use of spironolactone.…”

Section: Discussionmentioning

confidence: 99%

Pattern of Electrolytes Including Calcium and Magnesium Imbalance with Etiology Assessment in Patients Admitted in Endocrine Department of a Tertiary Care Hospital

Rahman¹,

Barua²,

Huq³

et al. 2020

IJDE

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Objectives: Several endocrine disorders have marked effects on fluid, electrolyte, and acid-base homeostasis including diabetic ketoacidosis, hyperglycemic hyperosmolar state, and acute adrenal crisis etc. An understanding of the etiology behind the development of these electrolytes along with calcium and magnesium imbalance helps to guide therapy and improves the clinical outcome. The aim of this study to see the pattern of electrolytes, calcium and magnesium imbalance with etiology assessment in patients admitted in endocrine department of a tertiary care hospital. Study design and methods: This cross sectional observational study was carried out from January 2018 to December 2018, at in-patient department of Endocrinology, BIRDEM General Hospital, Dhaka. Diagnosed (old and new) cases of diabetic and other endocrine disorders having electrolytes, calcium and magnesium imbalance were approached for sinclusion of the study. Sampling technique was purposively selected focusing on demographic profile and diagnosis of the disease. Results: Among the 100 participants, mean age of the study population was 46.26±16.97 years, ranging from 14 to 75 years. There were 50%-male and 50%-female. In result the most common electrolyte imbalance was hyponatremia (36%) that was more in type-2 DM patients (n=25) then in Addison's disease (n=4) and rest are in other specific form of DM (n=3), type-1 DM (n=2), DM with hypoparathyroidism (n=1) and hypoparathyroidism (n=1) which may be due to SIADH. Followed by hypokalemia (14%) which mostly encountered in type-2 DM patient (n=6) due to diuretics and in Conn's syndrome (n=4), hyperkalemia (10%) which mostly observed in type-1 DM patient (n=4) due to DKA, and hypercalcemia (8%) was found in non-diabetic endocrine disorders. Hypernatremia, hypocalcemia and hypomagnesemia were present in 7%, in 6%, and 6% cases, respectively. The most common precipitating cause of these electrolyte imbalances was vomiting (30%) due to different causes like urinary tract infection; acute gastritis and pancreatitis. Diuretic (Loop & Thiazide) therapy (10%) and HHS (8%) were the second and third most common cause behind these electrolytes imbalance Conclusion: In conclusion data obtained in this study showed hyponatremia was the most common findings which more observed in diabetic patients. As vomiting is the most common cause behind this so any diabetic patients either present with vomiting or any other illness should routinely advice electrolytes along with magnesium as hypomagnesemia also more observed in this group. To find out the cause of hypokalemia in non-diabetic patients should evaluate the Conn's syndrome and don't forget to measure the parathyroid hormone in hypercalcemic patient. Further study is needed to find out the causes of vomiting.

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“…Therefore, choice of intravenous fluids remains crucial for the clinicians to avoid any pitfalls. Treatment should always begin with infusing bolus crystalloid, especially 0.9% normal (isotonic) saline, at a rate of 15-20 milliliters per kilogram per hour or 1-1.5 L during the first hour, to maintain effective plasma osmolality (2,10,11). In Case 2, we continued with choice of normal saline in the maintenance phase as well, because the patient continued to be hypovolemic and dehydrated based on clinical evaluation.…”

Section: Discussionmentioning

confidence: 99%

“…Though one should be cautious about rapid correction of serum glucose and/or serum sodium respectively can precipitate cerebral edema. Therefore, the goal for correction in acute hypernatremia by decreasing plasma sodium concentration at most 2 mol/L/h until plasma concentration is 145 mmol/L (10,11).…”

Section: Discussionmentioning

confidence: 99%

Salty diabetes: a case series of hypernatremia presenting with diabetic ketoacidosis

et al. 2019

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Hyponatremia is an expected electrolyte resultant in diabetic ketoacidosis (DKA) that presents secondary to the dilutional effect of hyperglycemia. However, hypernatremia in DKA is a rare presentation, more common in the pediatric population, that rides poor morbidity and mortality. We describe three cases of patients presenting with DKA and hypernatremia with altered sensorium and share details on pathophysiology and treatment that expand our understanding amongst clinicians.

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A Case of Diabetic Ketoacidosis Presenting with Hypernatremia, Hyperosmolarity, and Altered Sensorium

Cited by 6 publications

References 9 publications

Serum electrolytes levels in patients with type 2 diabetes mellitus: a cross-sectional study

Serum electrolytes levels in patients with type 2 diabetes mellitus: a cross-sectional study

Pattern of Electrolytes Including Calcium and Magnesium Imbalance with Etiology Assessment in Patients Admitted in Endocrine Department of a Tertiary Care Hospital

Salty diabetes: a case series of hypernatremia presenting with diabetic ketoacidosis

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