Endocrinology and Metabolism

Original Articles

Diabetes, Obesity and Metabolism
Effect of the Concomitant Use of Subcutaneous Basal Insulin and Intravenous Insulin Infusion in the Treatment of Severe Hyperglycemic Patients: Yejee Lim, Jung Hun Ohn, Joo Jeong, Jiwon Ryu, Sun-wook Kim, Jae Ho Cho, Hee-Sun Park, Hye Won Kim, Jongchan Lee, Eun Sun Kim, Nak-Hyun Kim, You Hwan Jo, Hak Chul Jang; Endocrinol Metab. 2022;37(3):444-454. Published online June 3, 2022; DOI: https://doi.org/10.3803/EnM.2021.1341

59,075 View
240 Download
3 Web of Science
3 Crossref

Abstract PDF Supplementary Material PubReader ePub

Background
No consensus exists regarding the early use of subcutaneous (SC) basal insulin facilitating the transition from continuous intravenous insulin infusion (CIII) to multiple SC insulin injections in patients with severe hyperglycemia other than diabetic ketoacidosis. This study evaluated the effect of early co-administration of SC basal insulin with CIII on glucose control in patients with severe hyperglycemia.
Methods
Patients who received CIII for the management of severe hyperglycemia were divided into two groups: the early basal insulin group (n=86) if they received the first SC basal insulin 0.25 U/kg body weight within 24 hours of CIII initiation and ≥4 hours before discontinuation, and the delayed basal insulin group (n=79) if they were not classified as the early basal insulin group. Rebound hyperglycemia was defined as blood glucose level of >250 mg/dL in 24 hours following CIII discontinuation. Propensity score matching (PSM) methods were additionally employed for adjusting the confounding factors (n=108).
Results
The rebound hyperglycemia incidence was significantly lower in the early basal insulin group than in the delayed basal insulin group (54.7% vs. 86.1%), despite using PSM methods (51.9%, 85.2%). The length of hospital stay was shorter in the early basal insulin group than in the delayed basal insulin group (8.5 days vs. 9.6 days, P=0.027). The hypoglycemia incidence did not differ between the groups.
Conclusion
Early co-administration of basal insulin with CIII prevents rebound hyperglycemia and shorten hospital stay without increasing the hypoglycemic events in patients with severe hyperglycemia.

Citations

Citations to this article as recorded by

16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2024
Nuha A. ElSayed, Grazia Aleppo, Raveendhara R. Bannuru, Dennis Bruemmer, Billy S. Collins, Laya Ekhlaspour, Rodolfo J. Galindo, Marisa E. Hilliard, Eric L. Johnson, Kamlesh Khunti, Ildiko Lingvay, Glenn Matfin, Rozalina G. McCoy, Mary Lou Perry, Scott J.
Diabetes Care.2024; 47(Supplement): S295. CrossRef
16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2023
Nuha A. ElSayed, Grazia Aleppo, Vanita R. Aroda, Raveendhara R. Bannuru, Florence M. Brown, Dennis Bruemmer, Billy S. Collins, Marisa E. Hilliard, Diana Isaacs, Eric L. Johnson, Scott Kahan, Kamlesh Khunti, Jose Leon, Sarah K. Lyons, Mary Lou Perry, Priya
Diabetes Care.2023; 46(Supplement): S267. CrossRef
Effectiveness and safety of early insulin glargine administration in combination with continuous intravenous insulin infusion in the management of diabetic ketoacidosis: A randomized controlled trial
Kitti Thammakosol, Chutintorn Sriphrapradang
Diabetes, Obesity and Metabolism.2023; 25(3): 815. CrossRef

Clinical Study
Trends in Hyperglycemic Crisis Hospitalizations and in- and out-of-Hospital Mortality in the Last Decade Based on Korean National Health Insurance Claims Data: Ji Hong You, Sun Ok Song, Se Hee Park, Kyoung Hye Park, Joo Young Nam, Dong Wook Kim, Hyun Min Kim, Dong-Jun Kim, Yong-ho Lee, Byung-Wan Lee; Endocrinol Metab. 2019;34(3):275-281. Published online September 26, 2019; DOI: https://doi.org/10.3803/EnM.2019.34.3.275

7,292 View
97 Download
8 Web of Science
10 Crossref

Abstract PDF PubReader ePub

Background

Hyperglycemic crisis is a metabolic emergency associated with diabetes mellitus. However, accurate epidemiologic information on cases of hyperglycemic crisis in Korea remains scarce. We evaluated trends in hyperglycemic crisis hospitalizations and in- and out-of-hospital mortality in Korea. We also predicted future trends.

Methods

We extracted claims data with hyperglycemic crisis as the principal diagnosis from the National Health Insurance Service database in Korea from January 2004 to December 2013. We investigated the numbers of claims with hyperglycemic crisis and identified trends in hyperglycemic crisis based on those claims data. We predicted future trends by statistical estimation.

Results

The total annual number of claims of hyperglycemic crisis increased from 2,674 in 2004 to 5,540 in 2013. Statistical analysis revealed an increasing trend in hyperglycemic crisis hospitalizations (P for trend <0.01). In contrast, the hospitalization rate per 1,000 diabetes cases showed a decreasing trend (P for trend <0.01) during this period. The mortality rate per 1,000 diabetes cases also showed a decreasing trend (P for trend <0.0001). However, no distinct linear trend in the case-related fatality rate at <60 days over the last decade was observed. The predicted number of annual claims of hyperglycemic crisis will increase by 2030.

Conclusion

The number of hyperglycemic crisis hospitalizations in Korea increased in the last decade, although the hospitalization rate per 1,000 diabetes cases and mortality rate decreased. Also, the predicted number of annual claims will increase in the future. Thus, it is necessary to establish long-term healthcare policies to prevent hyperglycemic crisis.

Citations

Citations to this article as recorded by

Enhancing outcome prediction by applying the 2019 WHO DM classification to adults with hyperglycemic crises: A single-center cohort in Thailand
Chatchon Kaewkrasaesin, Weerapat Kositanurit, Phawinpon Chotwanvirat, Nitchakarn Laichuthai
Diabetes & Metabolic Syndrome: Clinical Research & Reviews.2024; 18(4): 103012. CrossRef
Obesity and 30-day case fatality after hyperglycemic crisis hospitalizations in Korea: a national cohort study
Hojun Yoon, Hyun Ho Choi, Giwoong Choi, Sun Ok Song, Kyoung Hwa Ha, Dae Jung Kim
Cardiovascular Prevention and Pharmacotherapy.2023; 5(3): 74. CrossRef
Interpreting global trends in type 2 diabetes complications and mortality
Mohammed K. Ali, Jonathan Pearson-Stuttard, Elizabeth Selvin, Edward W. Gregg
Diabetologia.2022; 65(1): 3. CrossRef
Comparison of the clinical characteristics and outcomes of pediatric patients with and without diabetic ketoacidosis at the time of type 1 diabetes diagnosis
Young-Jun Seo, Chang Dae Kum, Jung Gi Rho, Young Suk Shim, Hae Sang Lee, Jin Soon Hwang
Annals of Pediatric Endocrinology & Metabolism.2022; 27(2): 126. CrossRef
Clinical characteristics and outcomes of care in patients hospitalized with diabetic ketoacidosis
Mohsen S. Eledrisi, Haifaa Alkabbani, Malk Aboawon, Aya Ali, Imad Alabdulrazzak, Maab Elhaj, Ashraf Ahmed, Hazim Alqahwachi, Joanne Daghfal, Salem A. Beshyah, Rayaz A. Malik
Diabetes Research and Clinical Practice.2022; 192: 110041. CrossRef
Hyperglycemic Crisis Characteristics and Outcome of Care in Adult Patients without and with a History of Diabetes in Tigrai, Ethiopia: Comparative Study
Getachew Gebremedhin, Fikre Enqueselassie, Helen Yifter, Negussie Deyessa
Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy.2021; Volume 14: 547. CrossRef
Increased Incidence of Pediatric Diabetic Ketoacidosis After COVID-19: A Two-Center Retrospective Study in Korea
Min Jeong Han, Jun Ho Heo
Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy.2021; Volume 14: 783. CrossRef
Acute Hyperglycemic Crises with Coronavirus Disease-19: Case Reports
Na-young Kim, Eunyeong Ha, Jun Sung Moon, Yong-Hoon Lee, Eun Young Choi
Diabetes & Metabolism Journal.2020; 44(2): 349. CrossRef
Letter: Trends in Hyperglycemic Crisis Hospitalizations and in- and out-of-Hospital Mortality in the Last Decade Based on Korean National Health Insurance Claims Data (Endocrinol Metab 2019;34:275–81, Ji Hong You et al.)
Jang Won Son
Endocrinology and Metabolism.2019; 34(4): 422. CrossRef
Response: Trends in Hyperglycemic Crisis Hospitalizations and in- and out-of-Hospital Mortality in the Last Decade Based on Korean National Health Insurance Claims Data (Endocrinol Metab 2019;34:275–81, Ji Hong You et al.)
Ji Hong You, Sun Ok Song
Endocrinology and Metabolism.2019; 34(4): 424. CrossRef

Clinical Study
Prognostic Factors in Patients Hospitalized with Diabetic Ketoacidosis: Avinash Agarwal, Ambuj Yadav, Manish Gutch, Shuchi Consul, Sukriti Kumar, Ved Prakash, Anil Kumar Gupta, Annesh Bhattacharjee; Endocrinol Metab. 2016;31(3):424-432. Published online September 1, 2016; DOI: https://doi.org/10.3803/EnM.2016.31.3.424

4,747 View
82 Download
28 Web of Science
26 Crossref

Abstract PDF PubReader

Background

Diabetic ketoacidosis (DKA) is characterized by a biochemical triad of hyperglycemia, acidosis, and ketonemia. This condition is life-threatening despite improvements in diabetic care. The purpose of this study was to evaluate the clinical and biochemical prognostic markers of DKA. We assessed correlations in prognostic markers with DKA-associated morbidity and mortality.

Methods

Two hundred and seventy patients that were hospitalized with DKA over a period of 2 years were evaluated clinically and by laboratory tests. Serial assays of serum electrolytes, glucose, and blood pH were performed, and clinical outcome was noted as either discharged to home or death.

Results

The analysis indicated that significant predictors included sex, history of type 1 diabetes mellitus or type 2 diabetes mellitus, systolic blood pressure, diastolic blood pressure, total leukocyte count, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, blood urea nitrogen, serum creatinine, serum magnesium, serum phosphate, serum osmolality, serum glutamic oxaloacetic transaminases, serum glutamic pyruvic transaminases, serum albumin, which were further regressed and subjected to multivariate logistic regression (MLR) analysis. The MLR analysis indicated that males were 7.93 times more likely to have favorable outcome compared with female patients (odds ratio, 7.93; 95% confidence interval, 3.99 to 13.51), while decreases in mean APACHE II score (14.83) and serum phosphate (4.38) at presentation may lead to 2.86- and 2.71-fold better outcomes, respectively, compared with higher levels (APACHE II score, 25.00; serum phosphate, 6.04).

Conclusion

Sex, baseline biochemical parameters such as APACHE II score, and phosphate level were important predictors of the DKA-associated mortality.

Citations

Citations to this article as recorded by

Prognosis of patients with extreme acidosis on admission to the emergency department: A retrospective cohort study
Amichai Gutgold, Shaden Salameh, Jeries Nashashibi, Yonatan Gershinsky
The American Journal of Emergency Medicine.2024; 76: 36. CrossRef
The critical role of pen needles and training in insulin delivery
Tracey Sainsbury
British Journal of Nursing.2024; 33(5): 242. CrossRef
Clinical characteristics of people with diabetic ketoacidosis at a clinic in The Gambia: a retrospective study
Orighomisan F Agboghoroma, Modou Jobe, Karen Forrest
Journal of Endocrinology, Metabolism and Diabetes of South Africa.2023; 28(1): 14. CrossRef
Elevated alanine transaminase is nonlinearly associated with in-hospital death in ICU-admitted diabetic ketoacidosis patients
Qiaoling Liu, Chen Gong, Yunjie Geng, Jiuhong You
Diabetes Research and Clinical Practice.2023; 197: 110555. CrossRef
Diabetic keto-acidosis in pancreatic diabetes – how is it different from DKA in type 1 or type 2 DM?
Sunetra Mondal, Riddhi DasGupta, Moushumi Lodh, Ashok Parida, Mandira Haldar, Arunangshu Ganguly
International Journal of Diabetes in Developing Countries.2023;[Epub] CrossRef
Comparative study of diabetic ketoacidosis in the elderly and non-elderly patients: A nine-year experience from an academic hospital in North India
Ashok Kumar Pannu, Ravindran Kiran, Abhishek Kumar, Saurabh Chandrabhan Sharda, Mandip Bhatia, Atul Saroch, Pinaki Dutta, Navneet Sharma
Diabetes & Metabolic Syndrome: Clinical Research & Reviews.2023; 17(12): 102903. CrossRef
Clinical Profile and Outcome of Diabetic Ketoacidosis in Type 1 and Type 2 Diabetes: A Comparative Study
Sachin Kamle, Madhuri Holay, Prashant Patil, Parimal Tayde
Vidarbha Journal of Internal Medicine.2022; 32: 21. CrossRef
Effect of subjective tool based aerobic exercise on pulmonary functions in patients with type 2 diabetes mellitus – a feasibility RCT
M. Saini, J. Kaur
Comparative Exercise Physiology.2022; 18(3): 239. CrossRef
Clinical characteristics and outcomes of care in patients hospitalized with diabetic ketoacidosis
Mohsen S. Eledrisi, Haifaa Alkabbani, Malk Aboawon, Aya Ali, Imad Alabdulrazzak, Maab Elhaj, Ashraf Ahmed, Hazim Alqahwachi, Joanne Daghfal, Salem A. Beshyah, Rayaz A. Malik
Diabetes Research and Clinical Practice.2022; 192: 110041. CrossRef
An Audit of Factors Impacting the Time to Resolution of the Metabolic Parameters in Diabetic Ketoacidosis Patients
Muath F AlWahbi , Sami H Alharbi, Saleh A Almesned, Faisal A Alfawzan, Rayan T Alsager, Abdullah A AlHojailan, Emad A Alfadhel, Fahad G Al-Harbi
Cureus.2022;[Epub] CrossRef
Incidence of Diabetic Ketoacidosis among Adults with Type 1 Diabetes in Saudi Arabia: Systematic review
Ayoub Ali Alshaikh, Rawan Zaifallh Alsalman, Nada Hamzah Albarqi, Razan Salem Alqahtani, Ali Ahmed Almontashri, Atheer Saud Alshahrani, Mohammed Abdullah Alshehri
Pharmacophore.2022; 13(4): 105. CrossRef
Features and long‐term outcomes of patients hospitalized for diabetic ketoacidosis
Michal Michaelis, Tzippy Shochat, Ilan Shimon, Amit Akirov
Diabetes/Metabolism Research and Reviews.2021;[Epub] CrossRef
Incidence, characteristics and long-term outcomes of patients with diabetic ketoacidosis: a prospective prognosis cohort study in an emergency department
Rachel Teixeira Leal Nunes, Carolina Frade Magalhães Girardin Pimentel Mota, Paulo Ricardo Gessolo Lins, Fernanda Salles Reis, Thais Castanheira de Freitas Resende, Ludmila de Andrade Barberino, Pedro Henrique Luiz da Silva, Aecio Flavio Teixeira de Gois
Sao Paulo Medical Journal.2021; 139(1): 10. CrossRef
Management of diabetic ketoacidosis in special populations
Mohsen S. Eledrisi, Salem A. Beshyah, Rayaz A. Malik
Diabetes Research and Clinical Practice.2021; 174: 108744. CrossRef
Profile of diabetic ketoacidosis at the National Diabetes and Endocrine Center in Tripoli, Libya, 2015
Aida Elkituni, Halla Elshwekh, Nesrein M. Bendala, Wafeya S. Atwear, Fawzia A. Aldaba, Abdulmunam M. Fellah
Diabetes & Metabolic Syndrome: Clinical Research & Reviews.2021; 15(3): 771. CrossRef
Frequency of Diabetic Ketoacidosis and Its Determinants Among Pediatric Diabetes Mellitus Patients in Northwest Ethiopia
Atitegeb Abera Kidie, Ayenew Molla Lakew, Tiruneh Ayele
Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy.2021; Volume 14: 4819. CrossRef
Diabetic ketoacidosis
Ketan K. Dhatariya, Nicole S. Glaser, Ethel Codner, Guillermo E. Umpierrez
Nature Reviews Disease Primers.2020;[Epub] CrossRef
Risk and Relevance of Insulin Pump Therapy in the Aetiology of Ketoacidosis in People with Type 1 Diabetes
Lena Christina Giessmann, Peter Herbert Kann
Experimental and Clinical Endocrinology & Diabetes.2020; 128(11): 745. CrossRef
Clinical and biochemical profile, precipitants and prognostic factors of diabetic ketoacidosis: A retrospective study from a tertiary care center of north India
Harpreet Singh, Atul Saroch, Ashok Kumar Pannu, H.J. Sachin, Navneet Sharma, Pinaki Dutta
Diabetes & Metabolic Syndrome: Clinical Research & Reviews.2019; 13(4): 2357. CrossRef
Sudden death due to diabetic ketoacidosis following power failure of an insulin pump: Autopsy and pump data
Mette Louise Blouner Gram Kjærulff, Birgitte Schmidt Astrup
Journal of Forensic and Legal Medicine.2019; 63: 34. CrossRef
Defining and characterising diabetic ketoacidosis in adults
Ketan K. Dhatariya
Diabetes Research and Clinical Practice.2019; 155: 107797. CrossRef
Effects of diabetic ketoacidosis in the respiratory system
Alice Gallo de Moraes, Salim Surani
World Journal of Diabetes.2019; 10(1): 16. CrossRef
Increasing Hospitalizations for DKA: A Need for Prevention Programs
Priyathama Vellanki, Guillermo E. Umpierrez
Diabetes Care.2018; 41(9): 1839. CrossRef
Guidelines and controversies in the management of diabetic ketoacidosis – A mini-review
Tasnim Islam, Khalid Sherani, Salim Surani, Abhay Vakil
World Journal of Diabetes.2018; 9(12): 226. CrossRef
Closing the Mortality Gap in Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State: Implications of a Clinical Decision Support App
Saperstein Y, Park J, McFarlane SI
International Journal of Clinical Endocrinology and Metabolism.2018; : 008. CrossRef
Incidence and prevalence of diabetic ketoacidosis (DKA) among adults with type 1 diabetes mellitus (T1D): a systematic literature review
Soulmaz Fazeli Farsani, Kimberly Brodovicz, Nima Soleymanlou, Jan Marquard, Erika Wissinger, Brett A Maiese
BMJ Open.2017; 7(7): e016587. CrossRef

Case Reports

Obesity and Metabolism
Olanzapine-Induced Diabetic Ketoacidosis and Neuroleptic Malignant Syndrome with Rhabdomyolysis: A Case Report: Young Kyoung Sa, Hyeon Yang, Hee Kyoung Jung, Jang Won Son, Seong Su Lee, Seong Rae Kim, Bong Yeon Cha, Ho Young Son, Chi-Un Pae, Soon Jib Yoo; Endocrinol Metab. 2013;28(1):70-75. Published online March 25, 2013; DOI: https://doi.org/10.3803/EnM.2013.28.1.70

3,933 View
37 Download
7 Crossref

Abstract PDF PubReader

Atypical antipsychotics have replaced conventional antipsychotics in the treatment of schizophrenia because they have less of a propensity to cause undesirable neurologic adverse events including extrapyramidal symptoms, tardive dyskinesia, and neuroleptic malignant syndrome (NMS). However, atypical antipsychotics have been known to result in various metabolic complications such as impaired glucose tolerance, diabetes and even diabetic ketoacidosis (DKA). In addition, a number of NMS cases have been reported in patients treated with atypical antipsychotics, although the absolute incidence of neurologic side effects is currently significantly low. Here, we report a patient who simultaneously developed DKA, acute renal failure and NMS with rhabdomyolysis after olanzapine treatment. Olanzapine-induced metabolic complications and NMS were dramatically improved with cessation of the olanzapine treatment and initiation of supportive management including fluid therapy, hemodialysis, and intensive glycemic control using insulin. At short-term follow-up, insulin secretion was markedly recovered as evidenced by a restoration of serum C-peptide level, and the patient no longer required any hypoglycemic medications. Despite the dramatic increase in the use of atypical antipsychotics treatment, individualized treatments along with careful monitoring may be prudent for high risk or vulnerable patients in order to avoid the development of metabolic side effects.

Citations

Citations to this article as recorded by

Neuroleptic malignant syndrome in a patient with moderate intellectual disability treated with olanzapine: A case report
Francesco Piacenza, Suet Kee Ong, Patrick O’Brien, Maurice Clancy
Clinical Case Reports.2021; 9(4): 2404. CrossRef
Succinylcholine-Induced Rhabdomyolysis in Adults: Case Report and Review of the Literature
Robert William Barrons, Liem T. Nguyen
Journal of Pharmacy Practice.2020; 33(1): 102. CrossRef
Improvement in renal prognosis with prompt hemodialysis in hyperosmolar hyperglycemic state-related rhabdomyolysis
I-Wen Chen, Cheng-Wei Lin
Medicine.2018; 97(50): e13647. CrossRef
Treatment of Diabetic Ketoacidosis Associated With Antipsychotic Medication
Antonia Vuk, Maja Baretic, Martina Matovinovic Osvatic, Igor Filipcic, Nikolina Jovanovic, Martina Rojnic Kuzman
Journal of Clinical Psychopharmacology.2017; 37(5): 584. CrossRef
A Case of Primary Hypoparathyroidism Presenting with Acute Kidney Injury Secondary to Rhabdomyolysis
Abdullah Sumnu, Zeki Aydin, Meltem Gursu, Sami Uzun, Serhat Karadag, Egemen Cebeci, Savas Ozturk, Rumeyza Kazancioglu
Case Reports in Nephrology.2016; 2016: 1. CrossRef
Nanoneurotherapeutics approach intended for direct nose to brain delivery
Shadab Md, Gulam Mustafa, Sanjula Baboota, Javed Ali
Drug Development and Industrial Pharmacy.2015; 41(12): 1922. CrossRef
Brief Review of Articles in 'Endocrinology and Metabolism' in 2013
Won-Young Lee
Endocrinology and Metabolism.2014; 29(3): 251. CrossRef

A Case of Simultaneous Presentation of Thyroid Crisis and Diabetic Ketoacidosis.: Kyung Ae Lee, Kyung Taek Park, Hea Min Yu, Heung Yong Jin, Ji Hyun Park, Hong Sun Baek, Tae Sun Park; Endocrinol Metab. 2012;27(1):63-67. Published online March 1, 2012; DOI: https://doi.org/10.3803/EnM.2012.27.1.63

2,095 View
31 Download
1 Crossref

Abstract PDF

Two important endocrine emergencies, thyroid crisis and diabetic ketoacidosis (DKA), are uncommon when presented together, but pose serious complications. Without appropriate management, they may result in high mortality. Although several cases of simultaneous presentation of thyroid crisis and DKA have been reported, it is a clinically unusual situation and remains a diagnostic and management challenge in clinical practice. We report rare case with simultaneous presentation of thyroid crisis and DKA without previous warning symptoms. A 23-year-old-woman was brought to the emergency department presenting with acute abdominal pain for one day. She was healthy and there was no personal history of diabetes or thyroid disease. Through careful physical examination and laboratory tests, the patient was diagnosed with thyroid crisis combined with DKA. Concomitance of these two endocrine emergencies led to sudden cardiac arrest, but she was successfully resuscitated. This emphasizes the importance of early recognition and prompt management when the two diseases are presented concomitantly.

Citations

Citations to this article as recorded by

Health Behaviors and Risk Factors Associated with Chronic Kidney Disease in Korean Patients with Diabetes: The Fourth Korean National Health and Nutritional Examination Survey
Suk Jeong Lee, Chae Weon Chung
Asian Nursing Research.2014; 8(1): 8. CrossRef

Diabetic Ketoacidosis Associated with Emphysematous Gastritis: A Case Report.: Young Min Choi, Jun Won Seo, Woo Jin Lee, Hyeong Jin Park, Ji Hye Shin, Seung Bum Kang, Jun Lee, Jin Hwa Kim, Sang Yong Kim, Hak Yeon Bae; Endocrinol Metab. 2011;26(4):355-359. Published online December 1, 2011; DOI: https://doi.org/10.3803/EnM.2011.26.4.355

22,806 View
30 Download

Abstract PDF: Diabetic ketoacidosis is a serious and demanding medical emergency for the field of endocrinology, and the identification and correction of the precipitating factors is equally important. Many patients of diabetic ketoacidosis show gastrointestinal symptoms as an initial presentation, and coincidental gastrointestinal diseases can be neglected or misdiagnosed. Emphysematous gastritis is a rare and lethal disease in which gas bubbles form in the stomach wall. The predisposing factors include ingestion of corrosive substances, alcohol abuse, diabetes, and immunosuppressive therapy. Thus, it may be difficult to detect emphysematous gastritis early, especially when it is developed in conjunction with diabetic ketoacidosis. We report a case of diabetic ketoacidosis associated with emphysematous gastritis in a young male without medical history.

Original Article

Clinical Characteristics of Patients with Hyperglycemic Emergency State Accompanying Rhabdomyolysis.: Soo Kyoung Kim, Jong Ha Baek, Kyeong Ju Lee, Jong Ryeal Hahm, Jung Hwa Jung, Hee Jin Kim, Ho Su Kim, Sungsu Kim, Soon Il Chung, Tae Sik Jung; Endocrinol Metab. 2011;26(4):317-323. Published online December 1, 2011; DOI: https://doi.org/10.3803/EnM.2011.26.4.317

22,592 View
24 Download
3 Crossref

Abstract PDF

BACKGROUND
The purpose of this study was to investigate the prevalence of rhabdomyolysis and its association with both clinical course and prognosis and to evaluate the factors associated with rhabdomyolysis in patients with hyperglycemic emergencies. METHODS: We reviewed the medical records of patients with hyperglycemic emergencies who visited our hospital from May 2003 to April 2010. We assessed the clinical characteristics, biochemical profiles and clinical course of patients and analyzed these data according to the presence of rhabdomyolysis. RESULTS: The prevalence of rhabdomyolysis was 29 patients (28.4%) among 102 patients. Mean serum osmolarity, glucose and serum creatinine levels were higher in patients with rhabdomyolysis than those without rhabdomyolysis. Patients with rhabdomyolysis had higher rates of hemodialysis and mortality than those without the condition. The factors associated with rhabdomyolysis in the hyperglycemic emergency state were increased serum osmolarity and APACHE II score on admission (P < 0.05). CONCLUSION: Rhabdomyolysis commonly occurred in patients with hyperglycemic emergencies and this could aggravate their clinical course and increase mortality.

Citations

Citations to this article as recorded by

Acute diabetes complications
Salvatore Piro, Francesco Purrello
Journal of Gerontology and Geriatrics.2021; 69(4): 269. CrossRef
The Authors Reply: Clinical and Biochemical Characteristics of Elderly Patients With Hyperglycemic Emergency State at a Single Institution
Yong Jung Cho
Annals of Geriatric Medicine and Research.2017; 21(1): 38. CrossRef
Clinical and Biochemical Characteristics of Elderly Patients With Hyperglycemic Emergency State at a Single Institution
Yun Jae Shin, Dae In Kim, Dong Won Lee, Beung Kwan Jeon, Jung Geun Ji, Jung Ah Lim, Young Jung Cho, Hong Woo Nam
Annals of Geriatric Medicine and Research.2016; 20(4): 185. CrossRef

Case Reports

New Onset Diabetic Ketoacidosis Associated with Quetiapine.: Soo Hyoung Lee; Endocrinol Metab. 2010;25(3):231-235. Published online September 1, 2010; DOI: https://doi.org/10.3803/EnM.2010.25.3.231

1,865 View
24 Download

Abstract PDF: New onset diabetes and diabetic ketoacidosis have been reported with administering atypical antipsychotics. Whereas clozapine and olanzapine are associated with a relatively high incidence of new onset diabetes and diabetic ketoacidosis, there are few case reports that have has been documented implicating quetiapine as the contributor to causing diabetes and diabetic ketoacidosis. I report here on a case of diabetic ketoacidosis that developed in a patient who was associated with quetiapine therapy. A 32-year-old woman with schizophrenia was transferred to the emergency room with diabetic ketoacidosis and vaginal bleeding. Seventeen months before this episode, she was hospitalized in an inpatient psychiatric institution and treated with quetiapine 1200mg, haloperidol 3mg, diazepam 5mg and benztropine 3mg with normal blood glucose levels. She had no personal and familial history of diabetes mellitus. She had no risk factors for diabetes mellitus and she also had no precipitating factor for diabetic ketoacidosis except for taking the atypical antipsychotic quetiapine. I believe that this case is the first case report of quetiapine associated diabetic ketoacidosis in Korea. Considering the unpredictability of hyperglycemia associated with quetiapine, monitoring the blood glucose should be part of the routine care when administering quetiapine.

Diabetic Ketoacidosis in a Patient with Long-term Clozapine Therapy.: Youn Joo Jeon, Seung Hwan Lee, Se Na Jang, Eun Sun Kim, Jeong Yo Min, Ji Hyun Kim, Soon Hwa Hong, Jae Hyoung Cho, Hyuk Sang Kwon, Kun Ho Yoon, Bong Yun Cha, Ho Young Son; J Korean Endocr Soc. 2007;22(5):376-380. Published online October 1, 2007; DOI: https://doi.org/10.3803/jkes.2007.22.5.376

1,776 View
20 Download
2 Crossref

Abstract PDF

With the broad use of atypical anti-psychotics, altered glucose metabolism has become an item of concern to clinicians and patients. Among the atypical anti-psychotics, clozapine and olanzapine are associated with a relatively high incidence of diabetic ketoacidosis and newly developed diabetes. We report a case of diabetic ketoacidosis in a patient with long-term clozapine therapy. A 35-year-old male with schizophrenia, treated with clozapine for 9 years was admitted into hospital because of comatous mentality. Although never diagnosed with diabetes before, his clinical features were consistent with diabetic ketoacidosis and shock. The patient's serum amylase and lipase levels were elevated and an abdominal computed tomography showed peripancreatic fat infiltration, suggesting the possibility of acute pancreatitis. The patient's serum glucose levels normalized shortly after clozapine treatment. Moreover, the patient ceased all glucose lowering agents upon hospital discharge, and maintained normal blood glucose levels thereafter. As observed in this case, clinicians should carefully screen and monitor blood glucose levels and other clinical parameters in patients treated with atypical anti-psychotics.

Citations

Citations to this article as recorded by

Two Cases of Diabetic Ketoacidosis Associated with Paliperidone Treatment in Schizophrenia
Hyun Ho Kim, Hae Kyung Yang, Hyoju Ham, Ho Wook Jeon, Joon Yub Lee, Sea Won Hwang, Bo Hyun Jang, Gi June Min, Jeong Min Lee, Seung-Hwan Lee
The Journal of Korean Diabetes.2014; 15(3): 178. CrossRef
Olanzapine-Induced Diabetic Ketoacidosis and Neuroleptic Malignant Syndrome with Rhabdomyolysis: A Case Report
Young Kyoung Sa, Hyeon Yang, Hee Kyoung Jung, Jang Won Son, Seong Su Lee, Seong Rae Kim, Bong Yeon Cha, Ho Young Son, Chi-Un Pae, Soon Jib Yoo
Endocrinology and Metabolism.2013; 28(1): 70. CrossRef

Diabetic Ketoacidosis in a Patient with Acromegaly.: Eun Hee Koh, Min Kyung Kim, Jin Tae Park, Il Seong Nam-Goong, Joong Yeol Park, Ki Up Lee, Min Seon Kim; J Korean Endocr Soc. 2004;19(4):393-398. Published online August 1, 2004

1,070 View
23 Download

Abstract PDF: Acromegaly is a chronic, debilitating condition caused by excessive secretion of growth hormone (GH). Impaired glucose tolerance is present in about 20-40% of acromegaly, with diabetes mellitus developing in about 10~15% of patients, but diabetic ketoacidosis is a rare association. Herein is reported a case of diabetic ketoacidosis in a 33 year-old female, with a 4 year history of typical acromegaly features. She presented with severe hyperglycemia and ketoacidosis, but with no other cause for this metabolic derangement. She had elevated plasma GH (50 ng/mL) and IGF-1 (1533 ng/mL) levels, and a pituitary macroadenoma. About 200 units of insulin per day were required for her glycemic control. However, the serum IGF-1 level and daily insulin requirement were significantly tapered after a transsphenoidal adenomectomy and long acting somatostatin analogue treatment. There was a good correlation with the daily insulin requirement and plasma IGF-1 level. This case demonstrates that severe GH excess can cause diabetic ketoacidosis, and that its successful treatment improves glucose metabolism.

A Case of Acromegaly with Diabetic Ketoacidosis and Hypertriglyceridemia-Induced Acute Pancreatitis .: Choon Young Lee, Moon Kyu Lee, Sun Young Lee, Sung No Hong, Hyung Hoon Kim, Bo Hyun Kang, Han Wook Kang, Byung Wan Lee, Yu Jeong Park, Yong Ki Min, Myung Shik Lee, Kwang Won Kim, Jong Hyun Kim; J Korean Endocr Soc. 2002;17(1):110-116. Published online February 1, 2002

1,099 View
20 Download

Abstract PDF: Secondary diabetes mellitus caused by increased growth hormone secretion (GH) has well been known. There is a close association between glucose intolerance and GH secretion, and increased GH level itself probably worsens the blood glucose control and lipid profile by increasing glycogenolysis and / or gluconeogenesis and by suppressing lipase activity. We report a case of acromegaly with diabetic ketoacidosis as and hypertriglyceridemia-induced acute pancreatitis. A 38 year old male, previously diagnosed to have acromegaly and diabetes, presented with nausea, vomiting, diffuse abdominal pain and altered mentality. There was no history of drug or alcohol consumption, blood gas analysis showed severe acidosis and urinanalysis for ketone was positive. His serum blood glucose, amylase and lipase levels were 494 mg/dL, 331 U/L, and 1288 U/L, respectively (reference values: 70~110 mg/dL, 13~100 U/L and 13~190 U/L, respectively). The patient was diagnosed as having diabetic ketoacidosis and acute pancreatitis. With the serum concentration of triglyceride being 1488 mg/dL and the absence of any obvious precipitating factors, we considered hypertriglyceridemia to be the cause of acute pancreatitis. He was treated with continuous intravenous insulin infusion, lipid lowering agent, and fluid replacement. After conservative management, general condition gradually improved and his serum amylase, lipase and triglyceride levels were all normalized. GH level was not suppressed under 2 ng/mL during oral glucose loading test, and basal GH and IGF levels were 231 ng/mL and 29.5 ng/mL, respectively. Sella MRI showed a 3.7 cm sized pituitary mass. On the 55th day of admission, transsphenoidal surgery was performed. In immunohistochemical staining, the pathologic tumor specimen was proved to be GH positive pituitary adenoma. This is the first case reported in the English literature of an acromegaly presenting with diabetic ketoacidosis and acute pancreatitis

First
Prev
Page of 1
Next
Last

Search