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Diabetic Coma
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1. Coma with diffuse white matter hemorrhages in juvenile diabetic ketoacidosis.
Match Strength: 11.528

Cerebral edema is the most common neurologic complication of diabetic ketoacidosis in children. A minority of young patients with intracerebral crises in diabetic ketoacidosis present with cerebrovascular accidents. We report 2 adolescent patients with diabetic ketoacidosis who presented with coma and diffuse white matter hemorrhages in the absence of either cerebral edema or cerebrovascular accidents. These 2 cases illustrate a novel clinical and neuropathologic description of diffuse white matter hemorrhages, possibly related to a cytotoxic process as the underlying mechanism. These case ... Read More »
» Published in Pediatrics. 2007 Dec;120(6):e1540-6. Epub 2007 Nov 26.

2. Exaggerated Vasopressin Secretion And Attenuated Osmoregulated Thirst In Human Survivors Of Hyperosmolar Coma
Match Strength: 11.148

AIMS/HYPOTHESIS: To test the hypothesis that subnormal thirst sensation could contribute to the development of the hypernatraemia characteristic of hyperosmolar coma, we studied osmoregulation in survivors of hyperosmolar coma. METHODS: Eight survivors of hyperosmolar coma, eight control subjects with Type II (non-insulin-dependent) diabetes mellitus and eight healthy control subjects underwent water deprivation during which measurements of thirst, plasma osmolality and vasopressin were taken. RESULTS: Water deprivation caused greater peak plasma osmolality in the hyperosmolar coma group (301 ... Read More »
» Published in Diabetologia. 1999 May;42(5):534-8.

3. Hyperosmolar Diabetic Non-Ketotic Coma, Hyperkalaemia And An Unusual Near Death Experience
Match Strength: 11.039

Generally, cardiac arrest due to pulseless electrical activity has a poor outcome, except when reversible factors such as acute hyperkalaemia are identified and managed early. Hyperosmolar diabetic non-ketotic coma may lead to acute hyperkalaemia. Hyperosmolar diabetic non-ketotic coma is a metabolic emergency usually seen in elderly non-insulin dependent diabetics, characterized by severe hyperglycaemia, volume depletion, altered consciousness, confusion and less frequently neurological deficit. Cerebrovascular accident or transient ischaemic attack may be mistakenly diagnosed, particularly ... Read More »
» Published in Eur J Emerg Med. 2001 Mar;8(1):57-63.

4. Cerebral edema complicating nonketotic hyperosmolar coma.
Match Strength: 9.702

Cerebral edema as a complication of the therapy of diabetic coma has been described for over 50 years, although modern awareness dates to about 1967. Almost all cases have occurred in patients with diabetic ketoacidosis (DKA). Although a few cases of cerebral edema have been reported in patients with nonketotic hyperosmolar coma (NKHC), these are in general not well documented by either autopsy data of cat scans. Over a period of 9 years, I have encountered 5 patients who developed cerebral edema as a complication of the therapy of NKHC. The initial plasma glucose in these patients was 1,496 + ... Read More »
» Published in Miner Electrolyte Metab. 1986;12(5-6):383-9.

5. Nonketotic hyperosmolar coma in a patient with type 1 diabetes-related diabetic nephropathy: case report.
Match Strength: 9.603

Nonketotic hyperosmolar coma (NHC) is characterized by severe hyperglycemia; absence of, or only slight ketosis; nonketotic acidosis; severe dehydration; depressed sensorium or frank coma; and various neurologic signs. This condition is uncommon in type 1 diabetes. Because of little or no osmotic diuresis in patients with diabetic nephropathy, increases in plasma osmolality and therefore the likelihood of neurologic symptoms are limited. A 20-year-old male patient with type 1 diabetes with chronic kidney disease on conservative treatment (glomerular filtration rate [GFR], 18 mL/dk) presented ... Read More »
» Published in Adv Ther. 2005 Sep-Oct;22(5):429-32.

6. The spectrum of coma among people with diabetes in Cameroon: an appraisal of the implications and challenges at the Yaounde Central Hospital.
Match Strength: 9.602

The present study was undertaken to assess the prevalence and prognosis of comas, the most serious acute complications of diabetes, among people with diabetes in Cameroon. The medical records of diabetic patients admitted to the endocrinolgy service of the Yaounde Central Hospital between November 1999 and October 2002 were reviewed. For each patient, data were collected on past medical history, clinical parameters, results of laboratory investigations, treatment received, and outcome. Coma was found to account for 10.2% (52) of the 509 admissions of diabetic patients, and to be responsible ... Read More »
» Published in Ann Trop Med Parasitol. 2008 Jan;102(1):73-8.

7. Drug-Induced Hypoglycemic Coma In 102 Diabetic Patients
Match Strength: 9.542

BACKGROUND: Hypoglycemic coma is a continuous threat for diabetic patients treated with insulin and/or oral hypoglycemic agents; it may be associated with substantial morbidity and mortality. METHODS: We retrospectively reviewed our clinical experience with drug-induced hypoglycemic coma during a 7-year period. RESULTS: The study consisted of 102 patients and included 61 females and 41 males. The median age was 72 years. Ninety-two patients suffered from type 2 diabetes mellitus; 10 patients had type 1 diabetes mellitus. The median lowest blood glucose level was 1.77 mmol/L (32 mg/dL). Drug ... Read More »
» Published in Arch Intern Med. 1999 Feb 8;159(3):281-4.

8. Hypoglycaemic Admissions Among Diabetic Patients In Soweto, South Africa
Match Strength: 9.159

An audit of hypoglycaemic admissions among diabetic patients to Baragwanath Hospital, Soweto, South Africa was carried out prospectively during a recent 5-month period. A total of 51 episodes of biochemically confirmed hypoglycaemia (blood glucose < 2.2 mmol l-1 with coma or pre-coma, and requiring intravenous glucose) were observed in 43 patients. There was a wide range of ages (22-88 years) and an excess of males (27 M:16 F). Fourteen (33%) cases were associated with sulphonylurea (gliclazide) treatment. Doses of insulin or sulphonylureas were not excessive. The major cause precipitating the ... Read More »
» Published in Diabet Med. 1993 Mar;10(2):181-3.

9. Bilateral Basal Ganglion Haemorrhage In Diabetic Ketoacidotic Coma: Case Report
Match Strength: 8.968

We report bilateral oedema and haemorrhagic transformation in the basal ganglia of a 59-year old woman with severe diabetic ketoacidosis. Lack of cerebral vascular autoregulation, followed by blood-brain barrier disruption due to the so-called breakthrough mechanism is presumed to be the cause ... Read More »
» Published in Neuroradiology. 1999 Sep;41(9):670-3.

10. Concepts of fluid therapy in diabetic ketoacidosis and hyperosmolar hyperglycemic nonketotic coma.
Match Strength: 8.585

Despite many advances in the overall treatment of type I diabetes mellitus during the last few years, no major advance has been made in decreasing the mortality rate of diabetic ketoacidosis or hyperosmolar hyperglycemic nonketotic coma. A major concern in both of these disease states is the development of cerebral edema during treatment. The guiding principles of therapy in both disease states are rehydration, electrolyte replacement, insulin therapy, and treatment of any underlying illnesses. If the patient is hypotensive, therapy begins with colloid or normal saline administration to ... Read More »
» Published in Pediatr Clin North Am. 1990 Apr;37(2):313-21.

11. New-onset diabetic ketoacidosis induced by the addition of perospirone hydrochloride in a patient treated with risperidone.
Match Strength: 8.379

A 32-year-old man with a family history of type 2 diabetes mellitus presented with circulatory collapse and deep coma after 9 days of treatment with perospirone hydrochloride, a recently developed atypical antipsychotic agent available only in Japan. The new drug had been added to the long-standing treatment with risperidone. Diagnosed with diabetic ketoacidosis, he was given insulin and saline with discontinuation of all antipsychotics. Ultimately, diabetes was controlled by dietary therapy alone despite reintroduction of risperidone. The risk of new-onset diabetic ketoacidosis in patients ... Read More »
» Published in Intern Med. 2007;46(4):199-200. Epub 2007 Feb 15.

12. A possible hypophosphatemia-induced, life-threatening encephalopathy in diabetic ketoacidosis: a case report.
Match Strength: 7.936

Hypophosphatemia, a common metabolic disorder, is usually silent and diagnosed by blood tests. However, misdiagnosis may result in delayed phosphate repletion, responsible for significant morbidity and potential mortality. We report an exceptional case of hypophosphatemia-related, life-threatening encephalopathy. A 49-year-old type-1 diabetic woman was admitted to our intensive care unit with coma and severe ketoacidosis. Initial neurologic impairment worsened despite improvement in acid-base disturbances and glucose levels. The electroencephalogram showed bilateral spikes with a background ... Read More »
» Published in Am J Med Sci. 2007 Jun;333(6):384-6.

13. Diabetic and endocrine emergencies.
Match Strength: 7.881

Endocrine emergencies constitute only a small percentage of the emergency workload of general doctors, comprising about 1.5% of all hospital admission in England in 2004-5. Most of these are diabetes related with the remaining conditions totalling a few hundred cases at most. Hence any individual doctor might not have sufficient exposure to be confident in their management. This review discusses the management of diabetic ketoacidosis, hyperosmolar hyperglycaemic state, hypoglycaemia, hypercalcaemia, thyroid storm, myxoedema coma, acute adrenal insufficiency, phaeochromocytoma hypertensive ... Read More »
» Published in Postgrad Med J. 2007 Feb;83(976):79-86.

14. Top hospitals record a 71% lower mortality rate.
Match Strength: 7.208

Pancreatitis, pulmonary embolism, and diabetic acidosis and coma see the greatest improvements in mortality rates. Structure, process, and evaluation cited as the keys to achieving high quality. Available process measures from national organizations seem to contribute to lower mortality rates ... Read More »
» Published in Healthcare Benchmarks Qual Improv. 2007 Dec;14(12):141-3.

15. Hypoglycemia Induced By Hydroxychloroquine In A Type Ii Diabetic Treated For Polyarthritis
Match Strength: 7.193

A 77-year-old man with type II diabetes taking a stable dose of subcutaneous, twice daily human insulin developed symmetrical, inflammatory, rheumatoid factor positive polyarthritis. Within 2 weeks of starting therapy with prednisone 5 mg daily and hydroxychloroquine 400 mg daily he had 2 episodes of severe hypoglycemic coma requiring emergency care. His blood glucose became controlled again when his insulin was decreased by 37%. There are no reported cases of hypoglycemia in diabetic or nondiabetic patients treated with hydroxychloroquine. Hydroxychloroquine has been reported to reduce ... Read More »
» Published in J Rheumatol. 1999 Jan;26(1):195-6.

16. Diabetes mellitus is associated with hepatic encephalopathy in patients with HCV cirrhosis.
Match Strength: 7.122

OBJECTIVES: An increased ammonia level of gut bacterial origin is an important mediator in the pathogenesis of hepatic encephalopathy (HE), and constipation is a frequent precipitant of hepatic coma. Because diabetes mellitus (DM) may be associated with delayed gastrointestinal transit, we speculated that its presence in patients with HCV-related cirrhosis would predispose to and exacerbate HE. METHODS: Sixty-five patients (50 men, 15 women) with HCV-related cirrhosis attending a liver transplantation clinic were assessed for severity of liver disease and presence of DM in a cross-sectional ... Read More »
» Published in Am J Gastroenterol. 2006 Jul;101(7):1490-6. Comment in: Am J Gastroenterol. 2006 Oct;101(10):2244-6.

17. Diabetic Emergencies: Part 1. Hypoglycaemia
Match Strength: 7.117

Diabetes mellitus is a chronic, lifelong condition which can affect people of all ages, and is increasing in prevalence. Hypoglycaemia is probably the most common acute problem suffered by patients with diabetes. It is also a serious medical emergency with potentially fatal outcomes, and is the most common reason for patients with diabetes attending an accident and emergency (A&E) department. It is also a major source of anxiety for diabetics, particularly those controlled on insulin, and unfortunately, in the move towards ever tighter glycaemic control, it is inevitable that diabetics will ... Read More »
» Published in Accid Emerg Nurs. 1999 Oct;7(4):190-6.

18. Changing Profile Of Diabetic Ketosis
Match Strength: 7.110

Forty-three cases of diabetic ketosis were analysed to determine the mode of presentation, treatment modalities and outcome. Among these cases 62.8% were non-insulin dependent diabetes mellitus (NIDDM) patients and 37.2% belonged to the insulin dependent diabetes mellitus (IDDM) group. Six patients had blood glucose levels of more than 250 mg/dl but less than 300 mg/dl who were grouped separately for analysis under the term "euglycaemic diabetic ketoacidosis (EGDK)". Infection was the commonest precipitating factor in diabetic ketosis in all groups. Abdominal pain and vomiting occurred with ... Read More »
» Published in J Indian Med Assoc. 1997 Oct;95(10):540-2.

19. Diabetic Ketoacidosis in Children in Khartoum City, Sudan
Match Strength: 6.932

Ninety episodes of diabetic ketoacidosis (DKA) in 72 Sudanese children seen during a one year period were investigated. The age of the patients ranged from 3 to 16 years with a median of 12 years. Twenty-two episodes (24%) occurred in newly diagnosed patients and 68 (76%) in previously known diabetic children. The mean observation period defined as the number of days from each one of the episodes until next episode or end of survey divided by the total number of the episodes was 180 days. During this short period of observation 18 recurrent episodes were observed giving an annual recurrent ... Read More »
» Published in East Afr Med J. 1994 Feb;71(2):102-5.

20. Diabetic ketoacidosis: clinical presentation and precipitating factors at Kenyatta National Hospital, Nairobi.
Match Strength: 6.903

OBJECTIVE: To determine the clinico-laboratory features and precipitating factors of diabetic ketoacidosis (DKA) at Kenyatta National Hospital (KNH). DESIGN: Prospective cross-sectional study. SETTING: Inpatient medical and surgical wards of KNH. SUBJECTS: Adult patients aged 12 years and above with known or previously unknown diabetes hospitalised with a diagnosis of diabetic ketoacidosis. RESULTS: Over a nine month period, 48 patients had DKA out of 648 diabetic patients hospitalised within the period, one died before full evaluation. Mean (SD) age was 37 (18.12) years for males, 29.9 (14.3) ... Read More »
» Published in East Afr Med J. 2005 Dec;82(12 Suppl):S191-6.

21. Endocrine Emergencies
Match Strength: 6.812

Diabetic and endocrine emergencies are traditionally treated by the acute medical admitting team or accident and emergency department staff. Most will see diabetic emergencies on a regular basis, as they are common and both type 1 and type 2 disease are increasing in prevalence. Diabetic emergencies are usually easily treated and the patients discharged. However, it is vital not to become complacent as these disorders can lead to death. It is particularly important to follow local guidance and to involve the diabetes team both during and after each episode. Recently it has become clear that ... Read More »
» Published in Postgrad Med J. 2004 Sep;80(947):506-15.

22. Metabolic emergencies in diabetes.
Match Strength: 6.666

Hypoglycaemia is the commonest metabolic abnormality faced by diabetic patients on hypoglycaemic therapy including insulin. Diabetic keto-acidosis (DKA) requires prompt diagnosis and all patients arriving emergency with dehydration, shock, coma, severe respiratory difficulty and evidence of any major illness should be tested for capillary blood glucose (CBG) and urinary ketones urgently not to miss DKA. Hyperosmolar non-ketotic state complicates elderly type 2 diabetes with intercurrent infections (respiratory tract infection is commonest) characterised by severe dehydration, severe ... Read More »
» Published in J Indian Med Assoc. 2006 May;104(5):244-6, 248.

23. Reversible amnesia in a Type 1 diabetic patient and bilateral hippocampal lesions on magnetic resonance imaging (MRI).
Match Strength: 6.644

AIMS: Intensive insulin therapy of Type 1 diabetes limits its chronic complications, but is associated with an increased risk of severe hypoglycaemia and its neuroglycopenic consequences. METHODS: Case report. RESULTS: A 24-year-old male with 15 years' history of Type 1 diabetes, who was missing for 48 h, was found at home in ketoacidosis coma. Intensive care permitted a rapid improvement revealing an unexpected severe anterograde amnesia, confirmed by neuropsychological testing. MRI performed 4 days after admission showed abnormal bilateral hyperintensity signals on T2-weighted images in the ... Read More »
» Published in Diabet Med. 2001 Sep;18(9):761-3.

24. Reversal of Diabetes By Syngeneic Transplantation of a Radiation-Induced Rat Insulinoma
Match Strength: 6.505

The growth and metabolic effects of a radiation-induced rat insulinoma were examined after subcutaneous subscapular transplantation into normal and streptozotocin diabetic NEDH rats. Streptozotocin diabetic rats exhibited hyperglycaemia, hypoinsulinaemia, impaired glucose tolerance without an insulin response, polyuria, polydipsia, hyperphagia and weight loss. Transplantation of tumour fragments gradually improved the physical and metabolic state over the following 3 weeks. Coincident with a progressive rise in plasma insulin between 10 and 17 days, the diabetic rats gained weight and reduced ... Read More »
» Published in Diabetes Res Clin Pract. 1987 Mar-Apr;3(2):63-9.

25. Treatment of severe diabetic acidosis with tris-hydroxymethyl aminomethane in a thirteen-year-old child.
Match Strength: 6.422

Diabetic ketoacidosis is a severe complication of type I diabetes. A 13-year-old female (40 kg) patient was admitted to our Intensive Care Unit with severe metabolic acidosis (pH: 6.8), hyperglycemia (835 mg/dL) and coma. Her hemodynamic conditions were unstable and, even though a large amount of plasma expanders, crystalloids, and inotropic support were supplied, the patient went into cardiac arrest in the first hour of treatment. After resuscitation, a better hemodynamic balance was achieved and metabolic acidosis was treated with fluid replacement therapy, continuous insulin infusion, and ... Read More »
» Published in Minerva Anestesiol. 2008 Mar;74(3):93-5.

26. Inverse Distribution Of Serum Sodium And Potassium In Uncontrolled Inpatients With Diabetes Mellitus
Match Strength: 6.416

It has been reported that there is an inverse relationship between serum sodium (Na) and potassium (K) levels in patients with diabetic coma. The present study was undertaken to determine whether such an inverse relation depends upon plasma glucose levels in diabetic patients for their glycemic control. We examined two hundred and fifty-two patients with diabetes mellitus admitted to our hospital during the one-year period to control their plasma glucose levels, except for those having nephropathy or liver dysfunction. Serum Na and K, plasma glucose, and serum and urinary C-peptide levels were ... Read More »
» Published in Endocr J. 1999 Feb;46(1):75-80.

27. The Impact of Diabetes Mellitus on In-Hospital Stroke Mortality
Match Strength: 6.343

BACKGROUND AND PURPOSE: Diabetes mellitus is a strong risk factor for stroke. However, the prognosis in terms of mortality after a stroke is still unclear, especially in diabetic patients. The main purpose of this study was to compare and evaluate the features of stroke in patients having diabetes mellitus with those without diabetes mellitus and to identify factors that influence survival following a stroke. SUBJECTS AND METHODS: In a prospective hospital-based study consecutive patients with acute ischaemic stroke were enrolled. A single observer, using predefined diagnostic criteria ... Read More »
» Published in J Postgrad Med. 2003 Oct-Dec;49(4):307-9; discussion 309-10.

28. Pediatric intracranial pressure monitoring in hypoxic and nonhypoxic brain injury.
Match Strength: 6.270

We reviewed the results of all pediatric patients undergoing intracranial pressure (ICP) monitoring in a 2-year period at our institution. The outcome of patients suffering hypoxia or ischemic injuries (HII) is compared to those suffering non-hypoxic or non-ischemic injuries (NHII). Thirty-four patients had ICP monitors placed during the study period. Incomplete patient information led to the exclusion of 5 patients. An additional 5 patients were excluded because no measures to control ICP were taken after the monitor was placed. Twenty-four patients required treatment for raised ICP ... Read More »
» Published in Childs Nerv Syst. 1991 Feb;7(1):34-9.

29. Diabetes mellitus in sand rats (Psammomys obesus). Metabolic pattern during development of the diabetic syndrome.
Match Strength: 6.252

It has been reported that sand rats, naturally feeding on low-caloric-value plants containing a high concentration of salt, become obese and develop hyperglycemia when fed on a standard laboratory diet. The aim of this study was to examine the long-term effects of a synthetic-chow diet on the metabolic pattern of the diabetic syndrome in a large group of sand rats. While a few animals had a fulminant reaction with markedly decreased glucose tolerance, low plasma insulin levels, and death within 3-4 wk, most sand rats developed obesity and elevated plasma insulin levels. From the third month ... Read More »
» Published in Diabetes. 1984 May;33(5):438-43.

30. Cognitive functioning in children with early onset type 1 diabetes and severe hypoglycemia.
Match Strength: 6.203

OBJECTIVE: To investigate whether severe hypoglycemia in young children with early-onset type 1 diabetes (T1DM) is associated with subsequent abnormalities in cognitive status. STUDY DESIGN: Recruitment was from a large population-based database of children and adolescents with T1DM. Children and adolescents with early-onset T1DM (<6 years) were eligible for the study. Diabetic individuals (n = 41) with a prospectively documented history of seizure or coma were compared with peers with no history of severe hypoglycemic events (n = 43). A comprehensive test battery of learning and memory was ... Read More »
» Published in J Pediatr. 2005 Nov;147(5):680-5.

31. Long-term safety, efficacy and side-effects of continuous subcutaneous insulin infusion treatment for type 1 (insulin-dependent) diabetes mellitus: a one centre experience
Match Strength: 6.156

A follow-up study of 116 Type 1 (insulin-dependent) diabetic patients on long-term continuous subcutaneous insulin infusion was conducted after 4.5 +/- 0.2 years. The average HbA1c-value of these patients decreased by 1% to 6.7 +/- 0.1% during this observation period. Typical side effects of continuous subcutaneous insulin infusion such as skin inflammation at the catheter insertion site occurred with similar frequency as has been reported previously by other authors. Diabetic ketoacidosis (0.14 per patient year) and disabling hypoglycaemia (0.1 per patient year, including 0.05 hypoglycaemic ... Read More »
» Published in Diabetologia. 1989 Jul;32(7):421-6.

32. Diabetes mellitus in Kearns-Sayre syndrome.
Match Strength: 6.146

A 20-year-old woman with Kearns-Sayre syndrome (KSS) suddenly experienced two episodes of diabetic coma. She was studied to determine whether diabetes mellitus (DM) resulted from insulin resistance or from an insulin secretion abnormality, using the euglycemic glucose clamp technique and the glucagon tolerance test. She had a deficiency of insulin secretion from beta cells. It is important to recognize in practice the onset of DM in patients with mitochondrial myopathy. We would suggest that a genetic linkage or mitochondrial dysfunction may be responsible for the association of both disease ... Read More »
» Published in Eur Neurol. 1988;28(1):34-8.

33. Diagnostic values of combined glucose and lactate values in cerebrospinal fluid and vitreous humour--our experiences.
Match Strength: 6.142

The final diagnosis of death in hypoglycaemic or diabetic coma should always be done as a synopsis of anamnestic response, morphology, biochemical (glucose, lactate, HBA1c, ketonic bodies, insulin, and C-peptide) and toxicological findings. High glucose levels in vitreous humour (more than 13 mmol/L, 234 mg/dL) or combined values of glucose and lactate in vitreous humour or in cerebrospinal fluid over threshold values of 23.7 mmol/L (427 mg/dL) and 23.4 mmol/L (422 mg/dL) respectively, can be an indicator of the pre-mortem hyperglycaemic state with fatal outcome. The determination of glycated ... Read More »
» Published in Forensic Sci Int. 2004 Dec 2;146 Suppl:S19-23.

34. Health Perceptions of Diabetic Patients in the Redia Study
Match Strength: 6.134

AIM: To explore the beliefs and perceptions of type 2 diabetic patients in La Reunion where the disease is highly prevalent (17.5% among 30-69 yr old subjects) with a strong link to the metabolic syndrome and nutritional habits. METHODS: Two sets of data were analysed. An 80-item questionnaire explored the perceptions of causal factors, knowledge of complications and therapeutic issues in 331 known diabetic patients included in the REDIA study. The data were completed by semi-structured interviews of 40 diabetic patients in a hospital setting. RESULTS: Perceived causal factors of diabetes are ... Read More »
» Published in Diabetes Metab. 2006 Feb;32(1):50-5.

35. Klinefelter's Syndrome Accompanied By Diabetes Mellitus And Diabetes Insipidus
Match Strength: 6.114

The first case of Klinefelter's syndrome accompanied by diabetes insipidus and diabetes mellitus is reported. A 41-year-old man admitted for hyperosmolar diabetic coma with a past history of diabetes insipidus was diagnosed as having Klinefelter's syndrome by endocrinological examination and sex chromosome analysis. In this case, glucose tolerance test was normalized half a year later and blood glucose was well controlled with diet therapy alone ... Read More »
» Published in Intern Med. 1992 Jul;31(7):917-21.

36. The use of continuous hemodiafiltration in a patient with diabetic ketoacidosis.
Match Strength: 6.095

A variety of fatal complications are associated with diabetes mellitus. Among these, diabetic ketoacidosis (DKA) figures largely in fatalities in young diabetics. Although hyperosmotic diuresis in DKA causes extreme fluid loss, acute renal failure is less common than expected in DKA. We treated a case of severe DKA with associated coma, acute respiratory failure, and acute renal failure in a 24-year-old man who had been diagnosed with type 1 diabetes mellitus at age 19. The comatose patient had been intubated before transfer to our hospital for intensive care. Despite infusion with isotonic ... Read More »
» Published in J Anesth. 2006;20(2):129-31.

37. Health perceptions of diabetic patients in the REDIA study.
Match Strength: 6.027

AIM: To explore the beliefs and perceptions of type 2 diabetic patients in La Reunion where the disease is highly prevalent (17.5% among 30-69 yr old subjects) with a strong link to the metabolic syndrome and nutritional habits. METHODS: Two sets of data were analysed. An 80-item questionnaire explored the perceptions of causal factors, knowledge of complications and therapeutic issues in 331 known diabetic patients included in the REDIA study. The data were completed by semi-structured interviews of 40 diabetic patients in a hospital setting. RESULTS: Perceived causal factors of diabetes are ... Read More »
» Published in Diabetes Metab. 2006 Feb;32(1):50-5.

38. Endocrine problems in the chronically critically ill patient.
Match Strength: 6.015

The endocrine adaptations to critical illness are varied. In the diabetic patient, counterregulatory hormones predispose to insulin resistance and hyperglycemia, a derangement accentuated by the use of glucocorticoids and enteral or parenteral nutrition. Thyroid abnormalities include the euthyroid sick syndrome, which may manifest as a low T3, low T4, low TSH, or all three. Illness in patients with pre-existing hypothyroidism or hyperthyroidism may precipitate myxedema coma or thyroid storm, respectively. The most important issue related to calcium is that of acute hypercalcemia, which, in the ... Read More »
» Published in Clin Chest Med. 2001 Mar;22(1):193-208.

39. Gastric Outflow Obstruction Caused By Gall Stones And Leading To Death By Complex Metabolic Derangement
Match Strength: 5.730

A 67 year old woman was admitted with a three week history of vomiting, having become increasingly confused for three days. Investigations revealed deranged serum biochemistry consistent with a combination of a diabetic non-ketotic hyperosmolar state and a metabolic alkalosis consistent with gastric outflow obstruction. She was treated with intravenous saline, intravenous insulin, and subcutaneous heparin, but did not improve clinically and had an asystolic cardiac arrest the following day; she was transferred to the intensive care unit and despite treatment with inotropes she died 40 hours ... Read More »
» Published in J Clin Pathol. 1997 Nov;50(11):963-5.

40. Effects of metoprolol and carvedilol on preexisting and new on-set diabetes in patients with chronic heart failure {inverted exclamation}V data from the Carvedilol or metoprolol European Trial (COMET).
Match Strength: 5.715

Objective Beta-blocker therapy may worsen glucose metabolism. We studied the development of new onset diabetes in a large cohort of heart failure patients treated with either metoprolol or carvedilol. Design Prospective and retrospective analysis of a controlled clinical trial. Setting Multinational multicenter study Patients 3029 patients with chronic heart failure. Interventions Randomly assigned treatment with carvedilol (n=1511, target dose 50 mg daily) or metoprolol tartrate (n=1518, target dose 100 mg daily). Results Diabetic events (diabetic coma, peripheral gangrene, diabetic foot, de ... Read More »
» Published in Heart. 2007 Jan 19;

41. Pathophysiology of Diabetes Mellitus
Match Strength: 5.711

As we learn more about the pathophysiology of diabetes mellitus, we find that there is more yet to be learned. This may sound like a trite statement, but in reality it is true. The following article reviews the basic pathophysiology of both type 1 diabetes mellitus and type 2 diabetes mellitus as we understand it today. It continues on to reveal the "things that go wrong" when there is too much or too little glucose available to the body organs and especially to the brain. The article points out the signs and symptoms to be aware of when the person is in the acute state of diabetic ... Read More »
» Published in Crit Care Nurs Q. 2004 Apr-Jun;27(2):113-25.

42. Severe diabetic ketoacidosis: the need for large doses of insulin.
Match Strength: 5.703

A 21-year-old female with Type 1 diabetes mellitus (DM) presented in ketoacidosis. She received intravenous normal saline and insulin at 6 U/h and 1.26% sodium bicarbonate solution. After the blood glucose had fallen to 9.5 mmol/l, the saline infusion was changed to 5% glucose solution and the insulin infusion rate to 2 to 3 U/h. The next day the patient became more drowsy (Glasgow coma scale 13/15, later falling to 4/15). Computed tomography (CT) scan suggested cerebral oedema and the patient was treated with dexamethasone and mannitol. She remained critically ill for 48 h, eventually making ... Read More »
» Published in Diabet Med. 1999 Apr;16(4):347-50. Comment in:: Diabet Med. 1999 Apr;16(4):350-1., Diabet Med. 1999 Oct;16(10):884., Diabet Med. 2000 Apr;17(4):329.

43. Acute Complications Associated with the Use of Insulin Infusion Pumps
Match Strength: 5.646

Because insulin pump therapy is capable of providing insulin both at a slow continuous basal rate and in boluses, it more closely approximates physiologic insulin secretion than is possible with other methods of insulin administration. However, several short-comings are specifically related to the way insulin is delivered by pumps. These include increased risk of diabetic ketoacidosis and increased likelihood of infection at injection sites. The risk of hypoglycemic coma is apparently no greater with pump therapy than with conventional injections. Health professionals using pump therapy need a ... Read More »
» Published in Diabetes Educ. 1989 Jan-Feb;15(1):40-3.

44. Treatment of diabetic coma with low-dose hourly intramuscular insulin.
Match Strength: 5.636

Ten diabetics with severe hyperglycaemia were treated with hourly low-dose intramuscular insulin injections. Five patients were keto-acidotic with a mean initial plasma glucose of 842 mg/100 ml and 5 were non-ketotic with a mean initial plasma glucose of 1 223 mg/100 ml. In every case there was an approximately linear and predictable lowering of plasma glucose, the average rate being 79 mg/100 ml/h in the ketotic group and 132 mg/100 ml/h in the non-ketotic group. Results closely paralleled those reported with continuous low-dose infusion techniques and this study supports the view of Alberti ... Read More »
» Published in S Afr Med J. 1975 Apr 5;49(15):621-6.

45. Hypoglycemia Due To Nateglinide Administration in Diabetic Patient with Chronic Renal Failure
Match Strength: 5.605

A 56-year-old woman with diabetic triopathy, rheumatoid arthritis and chronic renal failure was admitted for severe hypoglycemic coma. Arthralgia had been deteriorating for 6 months. Therefore, 5 mg of prednisolone was administered. Postprandial blood glucose (PPG), however, elevated from 260 to 290 mg/dl, although fasting blood glucose (FBG) levels ranged from 80 to 110 mg/dl. Three months after, 270 mg of nateglinide was given in addition to acarbose. After 2 days, hypoglycemia occurred at 02:00 h. Nateglinide was then decreased to 180 mg (before breakfast and lunch). After 5 days, ... Read More »
» Published in Diabetes Res Clin Pract. 2003 Mar;59(3):191-4.

46. Prognostic Indices For Intra-Hospital Mortality In Nigerian Diabetic Niddm Patients. Role Of Gender And Hypertension
Match Strength: 5.589

Hypertension and diabetes mellitus are independently associated with a high rate of target organ complications, which is particularly accentuated in the Negroid race. The aims of this study were to evaluate the mortality associated with diabetes mellitus and concurrent hypertension and diabetes mellitus in indigenous Africans, and to identify and assess the factors that are predictive of intra-hospital mortality in Non-Insulin Dependent Diabetes Mellitus (NIDDM) diabetic Nigerians. The subsequent impact of the modification of these risk factors was also evaluated. A prospective study of 51 ... Read More »
» Published in J Diabetes Complications. 2000 Mar-Apr;14(2):84-9.

47. Diabetes In The United Kingdom: A Personal Series
Match Strength: 5.572

A personal series of 6780 patients with diabetes mellitus is reported. Of these 1410 were thought to have insulin-dependent (Type 1) diabetes and 4926 non-insulin-dependent (Type 2) diabetes. Among the former, 128 patients were only diagnosed when in severe ketoacidosis or coma. In 116 patients the diabetes was diagnosed in pregnancy. Chronic alcoholism was an aetiological factor in 75 patients; in 52 it led to the diagnosis being made, and it complicated treatment in 129 additional patients. In the patients with Type 2 diabetes whose treatment was stabilized 23.5% were having insulin ... Read More »
» Published in Diabet Med. 1991 Jan;8(1):59-68.

48. The management of diabetic ketoacidosis by continuous infusion of low-dose insulin using the ordinary intravenous plastic bag and tubing.
Match Strength: 5.522

Although the hourly intramuscular insulin regimen has been used in the management of diabetic ketoacidosis (DKA) in Ethiopia for over 7 years, continuous intravenous (IV) insulin infusion has never been previously used. In Tikur Anbessa Hospital, Addis Abeba, in 198788, we used the ordinary IV plastic bag and tubings alone to concurrently infuse the low-dose insulin and hydration solution in the management of 15 episodes of DKA in 13 patients, 5 males and 8 females. Initial blood glucose was over 400 mg/dl and urine ketones 4+ in all, and the level of consciousness ranged from drowsy to coma. ... Read More »
» Published in Ethiop Med J. 1991 Jan;29(1):7-13.

49. Acute Fulminant Hepatitis B in a Patient with Diabetic Nephropathy Treated Successfully with Concomitant Lamivudine and Molecular Adsorbents Recirculating System
Match Strength: 5.518

A 36-year-old man with type 2 diabetes and diabetic nephropathy treated with hemodialysis developed hepatitis B virus (HBV)-induced acute fulminant hepatic failure (FHF). Despite supportive treatment, the condition rapidly progressed as manifested by severe jaundice, coagulopathy and hepatic coma. He was placed on the waiting list for liver transplantation and was treated with lamivudine and extracoporeal liver support with the molecular adsorbent recirculating system (MARS). After three 8-h sessions of MARS treatment in 1 week, he had remarkable improvement in clinical symptoms and serum ... Read More »
» Published in J Infect. 2005 Oct 31; [Epub ahead of print]

50. Intensive Or Conventional Insulin Therapy In Type 2 Diabetic Patients? A Population-Based Study On Metabolic Control And Quality Of Life (The Jevin-Trial)
Match Strength: 5.425

Long-term micro- and macrovascular complications cause major morbidity and mortality in patients with type 2 diabetes mellitus. Up to the present it is not clear whether intensified or conventional insulin treatment is more effective to keep blood glucose concentrations close to the normal range. In the present trial 90% (n = 117) of all insulin-treated type 2 diabetic patients aged 16 to 60 years and living in the city of Jena (100,247 inhabitants), Thuringia, Germany were examined. Fourty patients (34%) were on intensive insulin therapy (ICT, > or = 2 injections of normal- and > or = 1 ... Read More »
» Published in Exp Clin Endocrinol Diabetes. 1999;107(8):506-11.

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