Clinical Case Database / Category: Case Based Discussion
Diabetic hyperglycaemic crises
Dr Joanna Wilson, Dr Barbara Philips, BSc, MD, FRCA, DICM (UK)
Foundation Years Journal, volume 3, issue 10, p.19 (123Doc Education, London, December 2009)
Introduction: type 2 diabetes mellitus is increasing in prevalence and patients may present in hyperglycaemic crisis. We present a case of mixed Diabetic Ketoacidosis (DKA) and Hyperglycaemic Hyperosmolar syndrome (HHS) in a previously unknown diabetic.
Case Presentation: a 49-year-old man presented to the A&E department with polydipsia, polyuria, weight loss and confusion. Biochemical testing revealed evidence of both DKA and HHS. He was transferred to the intensive care unit for further management.
Discussion: it is essential to distinguish between DKA and HHS because of differences in management, with outcome implications. HHS patients are at high risk of cerebral complications and mortality of up to 50% has been reported. Regimens aimed at treating patients with DKA, may exacerbate risk to patients with HHS who should be managed to minimise the risk of cerebral oedema.
Access the Clinical Cases Database
A subscription is required to read the full article. Please subscribe using one of the options below.
|Foundation Years Clinical Cases Database
|Foundation Years Clinical Cases Database
Dr Joanna Wilson
Foundation Year 1
St Georges Intensive Care Unit
St Georges Hospital
Dr Barbara Philips, BSc, MD, FRCA, DICM (UK) (Corresponding author)
Senior Lecturer/Honorary Consultant Intensive Care Medicine
St Georgeâ€™s University of London
London SW17 0R
tel: 020 8725 2615 (secretary)
fax: 020 8725 0256
2. NHS Health and Social Care Information Centre, http:\\www.hesonline.nhs.uk, accessed 15/07/09.
3. Fishbein H, Palumbo PJ (1995) âAcute metabolic complications in diabetesâ, in National Diabetes Data Group. Diabetes in America. Bethesda (MD): National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, pp. 283â291.
9. Kitabchi AE, Umpierrez GE, Murphy MB, et al. (2006) Hyperglycaemic crises in adult patients with diabetes: a consensus statement from the American Diabetes Association. Diabetes Care, 29: 2739â2748.
12. Hoorn EJ, Carlotti APCP, Costa LAA, et al. (2007) Preventing a Drop in Effective Plasma Osmolality to Minimise the Likelihood of Cerebral Edema During treatment of Children with Ketoacidosis. The Journal of Pediatrics, 150: 467â473.
Conflict Of Interest
The Journal requires that authors disclose any potential conflict of interest that they may have. This is clearly stated in the Journal’s published “Guidelines for Authors”. The Journal follows the Guidelines against Conflict of Interest published in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals (http://www.icmje.org/urm_full.pdf).
The authors of this article have not been paid. The Journal is financed by subscriptions and advertising. The Journal does not receive money from any other sources. The decision to accept or refuse this article for publication was free from financial considerations and was solely the responsibility of the Editorial Panel and Editor-in-Chief.
Patient Consent statement
All pictures and investigations shown in this article are shown with the patients’ consent. We require Authors to maintain patients’ anonymity and to obtain consent to report investigations and pictures involving human subjects when anonymity may be compromised. The Journal follows the Guidelines of the Uniform Requirements for Manuscripts (http://www.icmje.org/urm_full.pdf). The Journal requires in its Guidelines for Authors a statement from Authors that “the subject gave informed consent”.
Animal & Human Rights
When reporting experiments on human subjects, the Journal requires authors to indicate whether the procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the HelsinkiDeclaration of 1975, as revised in 2008.
About the Clinical Cases Database
The Foundation Years Clinical Cases Database is a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.
The database is fully searchable, or can be browsed by medical specialty. Abstracts can be read free of charge, however a subscription is required in order to read the complete cases.