1/3. Hyperglycemic hyperosmolar nonketotic syndrome in a child with acute lymphoblastic leukemia undergoing induction chemotherapy: case report.Hyperglycemic hyperosmolar nonketotic syndrome, a life-threatening complication commonly associated with uncontrolled type 2 diabetes mellitus in adults, is characterized by severe hyperglycemia, a marked increase in serum osmolality, and clinical evidence of dehydration without the accumulation of beta-hydroxybutyric or acetoacetic ketoacids. There is a variable alteration in sensorium. The syndrome has been rarely reported in children with leukemia undergoing induction therapy. The authors' aim is to sensitize physicians to this life-threatening illness, which can be treated effectively if diagnosed early.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/3. Hyperosmolar hyperglycemic crisis: an acute life-threatening event in children and adolescents with type 2 diabetes mellitus.OBJECTIVE: To discuss the initial clinical manifestations and management of 8 obese African American children and adolescents who presented with a severe hyper-osmolar hyperglycemic state (HHS) and were newly diagnosed with type 2 diabetes mellitus (DM), except for one who most likely had type 1 DM. methods: We summarize the clinical presentation, pertinent laboratory values, management, complications, outcome, and follow-up of 8 obese pediatric patients who had HHS and alteration of mental function. RESULTS: Seven male and one female African American patients from 11 to 17 years of age with a body mass index that exceeded the 97th percentile were treated for HHS. All patients had alteration of mental status, ranging from confusion to coma. Five patients had venous CO(2) levels <14 mEq/L. Corrected sodium in all patients was in the hypernatremic range in conjunction with high effective serum osmolality. After fluid replacement (the most important aspect of treatment), intravenous insulin therapy was initiated. Metabolic control was achieved in all patients within 36 hours after admission. Complete recovery ensued in all patients except one, who died on the sixth day of hospitalization, possibly attributable to massive pulmonary embolism. CONCLUSION: The incidence of obesity and type 2 DM in children and adolescents is increasing at an alarming rate. Many patients previously undiagnosed with type 2 DM may indeed present with HHS. Because experience and published literature regarding HHS in pediatric patients are meager, this is a new challenge for physicians. mortality and morbidity are high in this group of patients, and a high index of suspicion and awareness of this condition by physicians are warranted.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
3/3. An unusual case of mesenteric ischemia in a patient with new-onset diabetes mellitus.The early detection of acute mesenteric ischemia is crucial for the preservation of bowel viability. The emergency physician must have a high index of suspicion to identify mesenteric ischemia when there is a paucity of physical examination findings. We discuss the case of a patient who presented to the emergency department with confusion, hyperglycemia, abdominal tenderness, and metabolic acidosis who also developed mesenteric ischemia.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |