Hhnk Case Study

Author

Dipa Avichal, DO Resident Physician, Department of Internal Medicine, Einstein Healthcare Network

Dipa Avichal, DO is a member of the following medical societies: American College of Physicians, American Osteopathic Association

Disclosure: Nothing to disclose.

Coauthor(s)

Nissa C Blocher, MD Attending Physician, Division of Endocrinology, Associate Program Director, Endocrinology Fellowship, Albert Einstein Medical Center

Nissa C Blocher, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, American Medical Association, Endocrine Society, The Pituitary Society

Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD Professor Emeritus of Medicine, St Louis University School of Medicine

George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, International Society for Clinical Densitometry, Southern Society for Clinical Investigation, American College of Medical Practice Executives, American Association for Physician Leadership, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical and Translational Research, Endocrine Society

Disclosure: Nothing to disclose.

Additional Contributors

Robin R Hemphill, MD, MPH Associate Professor, Director, Quality and Safety, Department of Emergency Medicine, Emory University School of Medicine

Robin R Hemphill, MD, MPH is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Acknowledgements

Howard A Bessen, MD Professor of Medicine, Department of Emergency Medicine, University of California, Los Angeles, David Geffen School of Medicine; Program Director, Harbor-UCLA Medical Center

Howard A Bessen, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Joseph Michael Gonzalez-Campoy, MD, PhD, FACE Medical Director and CEO, Minnesota Center for Obesity, Metabolism, and Endocrinology

Joseph Michael Gonzalez-Campoy, MD, PhD, FACE is a member of the following medical societies: American Association of Clinical Endocrinologists, Association of Clinical Researchers and Educators (ACRE), and Minnesota Medical Association

Disclosure: Nothing to disclose.

George T Griffing, MD Professor of Medicine, St Louis University School of Medicine

George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, InternationalSocietyfor Clinical Densitometry, and Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Lewis S Nelson, MD, FACEP, FAACT, FACMT Associate Professor, Department of Emergency Medicine, New York University School of Medicine; Attending Physician, Department of Emergency Medicine, Bellevue Hospital Center, New York University Medical Center and New York Harbor Healthcare System

Lewis S Nelson, MD, FACEP, FAACT, FACMT is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

David S Schade, MD Chief, Division of Endocrinology and Metabolism, Professor, Department of Internal Medicine, University of New Mexico School of Medicine and Health Sciences Center

David S Schade, MD is a member of the following medical societies: American College of Physicians, American Diabetes Association, American Federation for Medical Research, Endocrine Society, New Mexico Medical Society, New York Academy of Sciences, and Society for Experimental Biology and Medicine

Disclosure: Nothing to disclose.

Don S Schalch, MD Professor Emeritus, Department of Internal Medicine, Division of Endocrinology, University of Wisconsin Hospitals and Clinics

Don S Schalch, MD is a member of the following medical societies: American Diabetes Association, American Federation for Medical Research, Central Society for Clinical Research, and Endocrine Society

Disclosure: Nothing to disclose.

Paulina B Sergot, MD Staff Physician, Department of Emergency Medicine, New York University/Bellevue Hospital Center

Paulina B Sergot, MD is a member of the following medical societies: American Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

1. Fishbein HA, Palumbo PJ. Acute metabolic complications in diabetes. In Diabetes in America National Diabetes Data Group, National Institutes of Health, 1995, p. 283–291 (NIH publ. no. 95-1468)

2. Rosenbloom AL. Hyperglycemic hyperosmolar state: an emerging pediatric problem. J Pediatr 2010;156:180–184 [PubMed]

3. Milionis HJ, Elisaf MS. Therapeutic management of hyperglycaemic hyperosmolar syndrome. Expert Opin Pharmacother 2005;6:1841–1849 [PubMed]

4. Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN. Hyperglycemic crises in adult patients with diabetes. Diabetes Care 2009;32:1335–1343 [PMC free article][PubMed]

5. Fadini GP, de Kreutzenberg SV, Rigato M, et al. . Characteristics and outcomes of the hyperglycemic hyperosmolar non-ketotic syndrome in a cohort of 51 consecutive cases at a single center. Diabetes Res Clin Pract 2011;94:172–179 [PubMed]

6. Wachtel TJ, Silliman RA, Lamberton P. Prognostic factors in the diabetic hyperosmolar state. J Am Geriatr Soc 1987;35:737–741 [PubMed]

7. Umpierrez GE, Kelly JP, Navarrete JE, Casals MM, Kitabchi AE. Hyperglycemic crises in urban blacks. Arch Intern Med 1997;157:669–675 [PubMed]

8. von Stosch A. Versuch einer Pathologie und Therapie des Diabetes Mellitus Berlin, Duncker und Humblot, 1828 [in German]

9. Warburg E. Some cases of diabetic coma complicated with uraemia, and some remarks on the previous history of the diabetic coma. Acta Med Scand 1925;61:301–334

10. Petters W. Untersuchungen über die Honigharnruhr. Vrtljschr Prakt Heilk 1857;3:81–94 [in German]

11. Foster B. Diabetic coma: acetonaemia. BMJ 1878;1:78–81 [PMC free article][PubMed]

12. Munson EL. The chemistry of the urine in diabetes mellitus. J Am Med Assoc 1897;28:831–836

13. Futcher T. Diabetic coma, aetiology, symptoms, and treatment. North N Y Med J 1897;66:821–825

14. Dreschfeld J. The Bradshawe Lecture on Diabetic Coma. BMJ 1886;2:358–363 [PMC free article][PubMed]

15. Kussmaul A. Zur lehre vom diabetes mellitus. Dtsch Arch Klin Med 1874;14:1–46[in German]

16. Adolf Kussmaul (1822-1902)—country doctor to clinical professor. JAMA 1964;189:58–59 [PubMed]

17. Joslin E. The Treatment of Diabetes Mellitus. 5th ed. Philadelphia, Lea & Febiger, 1935, p. 302–323

18. Stadelmann E. Ueber die Ursachen der pathologischen ammoniakausscheidung beim diabetes mellitus und des coma diabeticum. Arch Exp Pathol und Pharmakol 1883;17:419–444 [in German]

19. Külz E. Ueber eine neue linksdrehende saure (pseudo-oxybuttersaure). Zeitschr f Biologie 1884;20:165–178 [in German]

20. Minkowski O. Ueber das vorkommen von oxybuttersäure im harn bei diabetes mellitus. Arch Exp Pathol und Pharmakol 1884;18:35–48 [in German]

21. von Frerichs F. Über den diabetes, Berlin. August Hirschwald 1884;1884:113 [in German]

22. Rosenbloom J. A form of diabetic coma, not due to the acetone bodies. New York M. J. 1915;102:294–296

23. Starr P, Fitz R. The excretion of organic acids in the urine of patients with diabetes mellitus. Arch Intern Med 1924;33:97–108

24. Labbe M, Boulin R, Labbe M, Boulin R. Coma diabetique sans reaction de Gerhardt. Bull Mem Soc Med Paris 1933;49:313

25. Marble A, Root H, White P. Diabetic coma. N Engl J Med 1935;212:288–297

26. Root HF, Leech R. Diabetic coma and hyperglycemic stupor compared. Med Clin North Am 1946;30:1115–1130 [PubMed]

27. John HJ . Treatment of diabetic coma: clinical lecture at Atlantic City session. J Am Med Assoc 1935;105:587–592

28. Martin HE, Wick AN. Quantitative relationships between blood and urine ketone levels in diabetic ketosis. J Clin Invest 1943;22:235–241 [PMC free article][PubMed]

29. de Graeff J, Lips JB. Hypernatraemia in diabetes mellitus. Acta Med Scand 1957;157:71–75 [PubMed]

30. Sament S, Schwartz MB. Severe diabetic stupor without ketosis. S Afr Med J 1957;31:893–894 [PubMed]

31. Macaulay MB. Hyperosmolar non-ketotic diabetes. Postgrad Med J 1971;47:191–196 [PMC free article][PubMed]

32. Kitabchi AE, Umpierrez GE, Murphy MB, et al. . Management of hyperglycemic crises in patients with diabetes. Diabetes Care 2001;24:131–153 [PubMed]

33. Chupin M, Charbonnel B, Chupin F. C-peptide blood levels in keto-acidosis and in hyperosmolar non-ketotic diabetic coma. Acta Diabetol Lat 1981;18:123–128 [PubMed]

34. Luzi L, Barrett EJ, Groop LC, Ferrannini E, DeFronzo RA. Metabolic effects of low-dose insulin therapy on glucose metabolism in diabetic ketoacidosis. Diabetes 1988;37:1470–1477 [PubMed]

35. Miles JM, Haymond MW, Nissen SL, Gerich JE. Effects of free fatty acid availability, glucagon excess, and insulin deficiency on ketone body production in postabsorptive man. J Clin Invest 1983;71:1554–1561 [PMC free article][PubMed]

36. Gerich J, Penhos JC, Gutman RA, Recant L. Effect of dehydration and hyperosmolarity on glucose, free fatty acid and ketone body metabolism in the rat. Diabetes 1973;22:264–271 [PubMed]

37. Rains JL, Jain SK. Oxidative stress, insulin signaling, and diabetes. Free Radic Biol Med 2011;50:567–575 [PMC free article][PubMed]

38. Brownlee M. Biochemistry and molecular cell biology of diabetic complications. Nature 2001;414:813–820 [PubMed]

39. Stentz FB, Umpierrez GE, Cuervo R, Kitabchi AE. Proinflammatory cytokines, markers of cardiovascular risks, oxidative stress, and lipid peroxidation in patients with hyperglycemic crises. Diabetes 2004;53:2079–2086 [PubMed]

40. Wachtel TJ. The diabetic hyperosmolar state. Clin Geriatr Med 1990;6:797–806 [PubMed]

41. Wachtel TJ, Tetu-Mouradjian LM, Goldman DL, Ellis SE, O’Sullivan PS. Hyperosmolarity and acidosis in diabetes mellitus: a three-year experience in Rhode Island. J Gen Intern Med 1991;6:495–502 [PubMed]

42. Kitabchi AE, Wall BM. Diabetic ketoacidosis. Med Clin North Am 1995;79:9–37 [PubMed]

43. Lorber D. Nonketotic hypertonicity in diabetes mellitus. Med Clin North Am 1995;79:39–52 [PubMed]

44. Kitabchi AE, Fisher JN, Murphy MB, Rumbak MJ. Diabetic ketoacidosis and the hyperglycemic hyperosmolar nonketotic state. In Joslin's Diabetes Mellitus. 13th ed. Kahn CR, Weir GC, editors. , Eds. Philadelphia, Lea & Febiger, 1994, p. 738–770

45. Ananth J, Parameswaran S, Gunatilake S. Side effects of atypical antipsychotic drugs. Curr Pharm Des 2004;10:2219–2229 [PubMed]

46. Tavakoli SA, Arguisola MS. Diabetic ketoacidosis in a patient treated with olanzapine, valproic acid, and venlafaxine. South Med J 2003;96:729–730 [PubMed]

47. Wilson DR, D’Souza L, Sarkar N, Newton M, Hammond C. New-onset diabetes and ketoacidosis with atypical antipsychotics. Schizophr Res 2003;59:1–6 [PubMed]

48. Ekpebegh C, Longo-Mbenza B. Mortality in hyperglycemic crisis: a high association with infections and cerebrovascular disease. Minerva Endocrinol 2013;38:187–193 [PubMed]

49. Roefaro J, Mukherjee SM. Olanzapine-lnduced hyperglycemic nonketonic coma. Ann Pharmacother 2001;35:300–302 [PubMed]

50. Canarie MF, Bogue CW, Banasiak KJ, Weinzimer SA, Tamborlane WV. Decompensated hyperglycemic hyperosmolarity without significant ketoacidosis in the adolescent and young adult population. J Pediatr Endocrinol Metab 2007;20:1115–1124 [PubMed]

51. Fourtner SH, Weinzimer SA, Levitt Katz LE. Hyperglycemic hyperosmolar non-ketotic syndrome in children with type 2 diabetes. Pediatr Diabetes 2005;6:129–135 [PubMed]

52. Bagdure D, Rewers A, Campagna E, Sills MR. Epidemiology of hyperglycemic hyperosmolar syndrome in children hospitalized in USA. Pediatr Diabetes 2013;14:18–24 [PubMed]

53. McDonnell CM, Pedreira CC, Vadamalayan B, Cameron FJ, Werther GA. Diabetic ketoacidosis, hyperosmolarity and hypernatremia: are high-carbohydrate drinks worsening initial presentation?Pediatr Diabetes 2005;6:90–94 [PubMed]

54. Gerich JE, Martin MM, Recant L. Clinical and metabolic characteristics of hyperosmolar nonketotic coma. Diabetes 1971;20:228–238 [PubMed]

55. Arieff AI, Carroll HJ. Hyperosmolar nonketotic coma with hyperglycemia: abnormalities of lipid and carbohydrate metabolism. Metabolism 1971;20:529–538 [PubMed]

56. Arieff AI, Carroll HJ. Nonketotic hyperosmolar coma with hyperglycemia: clinical features, pathophysiology, renal function, acid-base balance, plasma-cerebrospinal fluid equilibria and the effects of therapy in 37 cases. Medicine (Baltimore) 1972;51:73–94 [PubMed]

57. Fulop M, Tannenbaum H, Dreyer N. Ketotic hyperosmolar coma. Lancet 1973;2:635–639 [PubMed]

58. Park BE, Meacham WF, Netsky MG. Nonketotic hyperglycemic hyperosmolar coma. Report of neurosurgical cases with a review of mechanisms and treatment. J Neurosurg 1976;44:409–417 [PubMed]

59. Zeitler P, Haqq A, Rosenbloom A, Glaser N; Drugs and Therapeutics Committee of the Lawson Wilkins Pediatric Endocrine Society. Hyperglycemic hyperosmolar syndrome in children: pathophysiological considerations and suggested guidelines for treatment. J Pediatr 2011;158:9–14 [PubMed]

60. Alberti KG, Hockaday TD. Diabetic coma: a reappraisal after five years. Clin Endocrinol Metab 1977;6:421–455 [PubMed]

61. Poser CM. Hyperglycemic non-ketotic coma. Role of sodium in the pathogenesis of the neurologic manifestations. Dis Nerv Syst 1972;33:725–729 [PubMed]

62. Feig PU, McCurdy DK. The hypertonic state. N Engl J Med 1977;297:1444–1454 [PubMed]

63. Gershengorn HB, Iwashyna TJ, Cooke CR, Scales DC, Kahn JM, Wunsch H. Variation in use of intensive care for adults with diabetic ketoacidosis. Crit Care Med 2012;40:2009–2015 [PMC free article][PubMed]

64. Reynolds ES. On the treatment of diabetic coma. Med Chron 1891;14:338–340

65. Chadbourne AP. A case of diabetic coma, treated by intravenous injection of saline solution; death. Boston Med Surg J 1890;122:623–625

66. Root H. The use of insulin and the abuse of glucose in the treatment of diabetic coma. JAMA 1945;127:557–563

67. Black AB, Malins JM. Diabetic ketosis; a comparison of results of orthodox and intensive methods of treatment based on 170 consecutive cases. Lancet 1949;1:56–59 [PubMed]

68. Hockaday TD, Alberti KG. Diabetic coma. Clin Endocrinol Metab 1972;1:751–788 [PubMed]

69. Alberti KG, Hockaday TD, Turner RC. Small doses of intramuscular insulin in the treatment of diabetic “coma.”Lancet 1973;2:515–522 [PubMed]

70. Kitabchi AE, Ayyagari V, Guerra SM. The efficacy of low-dose versus conventional therapy of insulin for treatment of diabetic ketoacidosis. Ann Intern Med 1976;84:633–638 [PubMed]

71. Fisher JN, Shahshahani MN, Kitabchi AE. Diabetic ketoacidosis: low-dose insulin therapy by various routes. N Engl J Med 1977;297:238–241 [PubMed]

72. Waldhäusl W, Kleinberger G, Korn A, Dudczak R, Bratusch-Marrain P, Nowotny P. Severe hyperglycemia: effects of rehydration on endocrine derangements and blood glucose concentration. Diabetes 1979;28:577–584 [PubMed]

73. Matz R. Management of the hyperosmolar hyperglycemic syndrome. Am Fam Physician 1999;60:1468–1476 [PubMed]

74. Cruz-Caudillo JC, Sabatini S. Diabetic hyperosmolar syndrome. Nephron 1995;69:201–210 [PubMed]

75. Ennis ED, Stahl EJVB, Kreisberg RA. The hyperosmolar hyperglycemic syndrome. Diabetes Rev 1994;2:115–126

76. Arieff AI. Cerebral edema complicating nonketotic hyperosmolar coma. Miner Electrolyte Metab 1986;12:383–389 [PubMed]

77. Arieff AI, Kleeman CR. Studies on mechanisms of cerebral edema in diabetic comas. Effects of hyperglycemia and rapid lowering of plasma glucose in normal rabbits. J Clin Invest 1973;52:571–583 [PMC free article][PubMed]

78. Halmos PB, Nelson JK, Lowry RC. Hyperosmolar non-ketoacidotic coma in diabetes. Lancet 1966;1:675–679 [PubMed]

79. Tripodi A, Branchi A, Chantarangkul V, et al. . Hypercoagulability in patients with type 2 diabetes mellitus detected by a thrombin generation assay. J Thromb Thrombolysis 2011;31:165–172 [PubMed]

80. Grant PJ, Tate GM, Hughes JR, Davies JA, Prentice CR. Does hypernatraemia promote thrombosis?Thromb Res 1985;40:393–399 [PubMed]

81. Heit JA, Leibson CL, Ashrani AA, Petterson TM, Bailey KR, Melton LJ, 3rd. Is diabetes mellitus an independent risk factor for venous thromboembolism?: a population-based case-control study. Arterioscler Thromb Vasc Biol 2009;29:1399–1405 [PMC free article][PubMed]

82. Keenan CR, Murin S, White RH. High risk for venous thromboembolism in diabetics with hyperosmolar state: comparison with other acute medical illnesses. J Thromb Haemost 2007;5:1185–1190 [PubMed]

83. Banting FG, Best CH, Collip JB, Campbell WR, Fletcher AA. Pancreatic extracts in the treatment of diabetes mellitus. Can Med Assoc J 1922;12:141–146 [PMC free article][PubMed]

84. Lawrence RD. The treatment of desperate cases of diabetic coma. BMJ 1930;1:690–692 [PMC free article][PubMed]

85. Singer DL, Drolette ME, Hurwitz D, Freinkel N. Serum osmolality and glucose in maturity onset diabetes mellitus. Arch Intern Med 1962;110:758–762 [PubMed]

86. Kitabchi AE, Umpierrez GE, Fisher JN, Murphy MB, Stentz FB. Thirty years of personal experience in hyperglycemic crises: diabetic ketoacidosis and hyperglycemic hyperosmolar state. J Clin Endocrinol Metab 2008;93:1541–1552 [PMC free article][PubMed]

87. Kitabchi AE, Umpierrez GE, Murphy MB, et al. American Diabetes Association . Hyperglycemic crises in diabetes. Diabetes Care 2004;27(Suppl. 1):S94–S102 [PubMed]

88. Butler AM. Diabetic coma. N Engl J Med 1950;243:648–659 [PubMed]

89. Lucas CP, Grant N, Daily WJ, Reaven GM. Diabetic coma without ketoacidosis. Lancet 1963;1:75–77 [PubMed]

90. Alstead S, Macgregor AG, Girdwood RH, Dunlop DM. Textbook of Medical Treatment. Edinburgh, Churchill Livingstone, 1971

91. Gerhardt J. Diabetes mellitus und aceton. Wien Med Presse 1865;6:672.[in German]

92. Lépine R. Le Diabète Sucré Alcan F, Ed. Paris, Ancienne Librairie Germer Baillière et Cie, 1909 [in French]

93. Revillet J. Coma chez une diabètique sans acétonurie. Lyon Med 1914;122:817 [in French]

94. McCaskey G. A case of fatal diabetic coma without diacetic or beta‐oxybutyric acid. JAMA 1916;66:350–351

95. Bock A, Field Jr H, Adair G. The acid-base equilibrium in diabetic coma, being a study of five cases treated with insulin. J Metab Res 1923;4:27

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