Hyperosmolar Non-Ketoacidotic Coma in Diabetes

Halmos, Pál; Nelson, Jim; Lowry, Richard C.

doi:10.1016/s0140-6736(66)91626-6

Cited by 69 publications

(34 citation statements)

References 15 publications

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“…in published reports of dialysisassociated hyperglycemia (DH) [11,13,18,[20][21][22][23][24][25][26][27][28][29][30][31] containing a total of 471 cases. Tables 2 and 3 summarize 1,002 reported cases of diabetic ketoacidosis (DKA) [3,[32][33][34][35][36][37][38][39][40][41][42] and 1,048 published cases of nonketotic hyperglycemia (NKH) [5,37,[39][40][41][42][43][44][45][46][47][48][49][50], respectively, in patients with preserved renal function. Figure 1 shows average serum K ?…”

Section: Introductionmentioning

confidence: 99%

Abnormalities of serum potassium concentration in dialysis-associated hyperglycemia and their correction with insulin: review of published reports

et al. 2010

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The main difference between dialysis-associated hyperglycemia (DH) and diabetic ketoacidosis (DKA) or nonketotic hyperglycemia (NKH) occurring in patients with preserved renal function is the absence of osmotic diuresis in DH, which eliminates the need for large fluid and solute (including potassium) replacement. We analyzed published reports of serum potassium (K(+)) abnormalities and their treatment in DH. Hyperkalemia was often present at presentation of DH with higher frequency and severity than in hyperglycemic syndromes in patients with preserved renal function. The frequency and severity of hyperkalemia were higher in DH episodes with DKA than those with NKH in both hemodialysis and peritoneal dialysis. For DKA, the frequency and severity of hyperkalemia were similar in hemodialysis and peritoneal dialysis. For NKH, hyperkalemia was more severe and frequent in hemodialysis than in peritoneal dialysis. Insulin infusion corrected the hyperkalemia of DH in most cases. Additional measures for the management of hyperkalemia or modest potassium infusions for hypokalemia were needed in a few DH episodes. The predictors of the decrease in serum K(+) during treatment of DH with insulin included the starting serum K(+) level, the decreases in serum values of glucose concentration and tonicity, and the increase in serum total carbon dioxide level. DH represents a risk factor for hyperkalemia. Insulin infusion is the only treatment for hyperkalemia usually required.

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Section: Introductionmentioning

confidence: 99%

Abnormalities of serum potassium concentration in dialysis-associated hyperglycemia and their correction with insulin: review of published reports

et al. 2010

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“…A literature review revealed several published case reports from the late 1960s and early 1970s that described this association [7][8][9][10]. However, prior epidemiologic studies have not consistently found diabetes to be strong risk factor for VTE, and so this association is controversial [11,12].…”

Section: Introductionmentioning

confidence: 99%

High risk for venous thromboembolism in diabetics with hyperosmolar state: comparison with other acute medical illnesses

Keenan

Murin

White

2007

Journal of Thrombosis and Haemostasis

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Summary. Background: Diabetes mellitus is generally not recognized as an important risk factor for venous thromboembolism (VTE). However, clinical observations and case reports have suggested that patients with diabetes and hyperosmolarity may be at increased risk for VTE. Objectives: To determine the risk of VTE in patients hospitalized for diabetes with hyperosmolar state compared to patients with other acute medical illnesses. Patients/methods: The California Patient Discharge Data Set was used to determine the incidence of first-time VTE in all patients admitted between 1995 and 2000 for diabetes with hyperosmolarity and 11 other acute medical conditions. Proportional hazard modeling was used to adjust for age, race, gender, and prior hospitalization within 3 months. Results: Among 2859 patients with diabetes and hyperosmolarity, 34 (1.2%) developed VTE during the hospitalization and 14 (0.5%) developed VTE within 91 days after discharge. In an adjusted multivariate model comparing the risk of VTE to cases with depression, patients with hyperosmolarity had a significantly higher risk of VTE [hazard ratio (HR) = 16.3; 95% confidence interval (CI): 10-25] comparable to the risk associated with sepsis (HR = 19.3; 95% CI: 13-29) or acute connective tissue disease (HR = 21; 95% CI: 15-31). Compared to uncomplicated diabetes, patients with hyperosmolarity had a significantly higher risk of VTE (HR = 3.0; 95% CI: 2.1-4.5) whereas patients with ketoacidosis were not at higher risk (HR = 1.2; 95% CI: 0.8-1.7). Conclusions: Patients hospitalized for diabetes with hyperosmolarity are at increased risk for developing VTE both during their inpatient stay and in the 3 months after discharge. Thromboprophylaxis in these patients appears warranted, and extended prophylaxis for after hospital discharge should be studied.

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“…All were successfully treated with 'loop' diu retics and increased fluid intake. In the series of 8 cases re ported by Halmos et al [46], all were hypotensive on admis sion. and 2 became oliguric requiring peritoneal dialysis.…”

Section: Complicationsmentioning

confidence: 89%