Alteraciones del equilibrio acido base y electrolíticas en pacientes con crisis hiperglicémica atendidos en emergencia de un hospital general de Chiclayo / Electrolyte and acid-base abnormalities in patients with hyperglycemic crisis attended at emergency in a general hospital in Chiclayo

Resumen Objetivo: Describir las alteraciones del equilibrio ácido base y electrolíticas en pacientes con crisis hiperglicémica atendidos en la emergencia de un hospital general de Chiclayo. Material y métodos: Serie de casos, prospectivo y de corte transversal; se seleccionaron pacientes diabéticos con crisis hiperglicémica que fueron vigilados por 3 horas. Se registraron los datos clínicos, demográficos, gases arteriales, glicemia y electrolitos. Resultados: Se evaluaron 52 pacientes con una edad promedio 55,1 ± 16,9 y 29 (55,8%) de sexo femenino. El tiempo promedio de diagnóstico fue 4,3 ± 5,4 meses; 13 (25,0%) eran episodios debut, 4 (7,7%) fallecieron. El síntoma más frecuente fue confusión mental en 14 (26,9%), 30 (57,7%) tuvieron falla renal aguda. Las alteraciones electrolíticas más frecuentes fueron hiponatremia en 26 (50,0%) e hipokalemia en 18 (34,6%). La acidosis metabólica fue más frecuente en cetoacidosis que en coma hiperosmolar (85,0 vs 15,0%; p= 0,000). La falla renal aguda ocurrió en 76,7% en cetoacidosis diabética y en 23,3% en el coma hiperosmolar (p= 0,74). Conclusiones: La frecuencia y las complicaciones de la cetoacidosis diabética y del coma hiperosmolar, así como de las alteraciones electrolíticas, muestran grandes diferencias con los datos reportados en la literatura.

Summary Objective: To describe electrolyte and acid-base imbalances in patients with hyperglycemic crisis attended at emergency in a general hospital in Chiclayo. Methods: A case series of diabetic patients with hyperglycemic crisis that were followed for 3 hours. Clinical, demographic, blood gases, serum glucose and electrolytes were gathered from patient´s charts. Results: 52 patients were evaluated; mean age was 55.1 ± 16.9 years and 29 (55.8%) were females. Mean time to diagnosis was 4.3 ± 5.4 months; 13 (25.0%) occurred at onset of diabetes and 4 (7.7%) died. The most common symptom was mental confusion in 14 (26,9%) of patients, 30 (57,7%) had acute renal failure. Hyponatremia in 26 (50.0%) patients and hypokalemia in 18 (34.6%) were the most common electrolyte abnormalities found. Metabolic acidosis was more frequently found in patients with ketoacidosis than in hyperosmolar coma (85.0 vs 15.0%; p<0.0001). Acute renal failure occurred in 76.7% among patients with ketoacidosis and in 23.3% of patients with hyperosmolar coma (p=0.74). Conclusions: the frequency and complications of diabetic ketoacidosis and of hyperosmolar coma as well as the electrolyte abnormalities differed from those reported in the literature.

Study on the outline of the continuous intravenous of the small dose of insulin in the treatment of the hyperosmolar coma due to diabetes mellitus

In oder to evaluate the effect of hyperglycemic control and potential complications of the recommended protocol using small doses of inssulin in treating the non- ketotic hyperosmolar diabetics. 22 studies partients were used Regular insulin with an initial dose of 0.1 IU/kg/h by continuous intravenous infusion. The dose of insulin was reduced to 0.05 IU/kg/h when the patient’s glycemia dropped to a level of 16 mmol/l. Results: 17 non ketotic hyperosmolar coma patients (77%) were successfully treated and discharged. No severe complications concerned with the inssulin therapy (such as hypoglycemia; hypokalemia) were noticed in this study. 5 patients died. The mean total dose of insulin in these patients during the first 24 h was not significantly different from that of the other survivals. Conclusions: the proposed small doses of insulin by continuous intravenous infusion showed a high and safe effect in treatment of non- ketotic hyperosmolar diabetics.

Two Cases of Diabetic Hyperglycemic Hyperosmolar Coma Treated with Maintaining CAPD in Chronic Renal Failure Patients with CAPD / 대한신장학회잡지

We reported two cases of diabetic hyperglycemic hyperosmolar coma treated with maintaining continuous ambulatory peritoneal dialysis(CAPD) in chronic renal failure(CRF) patients with CAPD. Hyperglycemia is common complication in CAPD, but there were only few reports of severe hyperglycemia accompanying with hyperosmolar coma in CRF patients on CAPD therapy. Furthermore, to date, no specific management for CAPD patients with nonketotic hyperosmolar coma has been established. The best strategy for management of hyperosmolar coma with CAPD patients is changing CAPD therapy to HD. Recently, we experienced two cases of hyperglycemic hyperosmolar coma in diabetic CAPD patients successfully treated with intravenous hydration and insulin therapy without discontinuing CAPD therapy. Because no such case has been reported, we report two cases of diabetic hyperosmolar coma with CAPD treated without conversion to HD. These cases suggest that adequate fluid replacement accompanying electrolytes and osmotic balance as well as insulin therapy might be a major role for safe treatment of hyperglycemic hyperosmolar coma in patient with CAPD.

Two Cases of Diabetic Hyperglycemic Hyperosmolar Coma Treated with Maintaining CAPD in Chronic Renal Failure Patients with CAPD / 대한신장학회잡지

We reported two cases of diabetic hyperglycemic hyperosmolar coma treated with maintaining continuous ambulatory peritoneal dialysis(CAPD) in chronic renal failure(CRF) patients with CAPD. Hyperglycemia is common complication in CAPD, but there were only few reports of severe hyperglycemia accompanying with hyperosmolar coma in CRF patients on CAPD therapy. Furthermore, to date, no specific management for CAPD patients with nonketotic hyperosmolar coma has been established. The best strategy for management of hyperosmolar coma with CAPD patients is changing CAPD therapy to HD. Recently, we experienced two cases of hyperglycemic hyperosmolar coma in diabetic CAPD patients successfully treated with intravenous hydration and insulin therapy without discontinuing CAPD therapy. Because no such case has been reported, we report two cases of diabetic hyperosmolar coma with CAPD treated without conversion to HD. These cases suggest that adequate fluid replacement accompanying electrolytes and osmotic balance as well as insulin therapy might be a major role for safe treatment of hyperglycemic hyperosmolar coma in patient with CAPD.

A case of diabetic hyperosmolar coma treated successfully with conversion to hemodialysis in a chronic renal failure patient on CAPD treatment / 대한내과학회지

Continuous ambulatory peritoneal dialysis(CAPD) is now the most important and effective therapeutic modality as well as hemodialysis(HD) and renal transplantation in patients with chronic renal failure. It is frequently recommended to diabetic renal failure patients because of poor, athersclerotic vascularity of them. Hyperglycemia and obesity are not uncommon complications of CAPD therapy. But there were only few reports of very severe hyperglycemia or hyperosmolar coma in CRF patients on CAPD therapy, especially with 7% dextrose CAPD dialysate in foreign countries in the past. Moreover, no specific management for hyperosmolar coma is established in those situations yet. In Korea, only three cases of hyperosmolar coma in non diabetic renal failure patient on CAPD therapy have been reported in one case report. And only one case among them whose CAPD therapy was changed to HD survived. Authors also experienced a case of diabetic hyperosmolar coma treated successfully with conversion to HD in chronic renal failure patient on CAPD therapy. So we report this case with a review of literature. Taken together with this case and review of literature, changing CAPD therapy to HD is regarded to be an important part of treatment when hyperosmolar coma develops in chronic renal failure patients.

A case of diabetic hyperosmolar coma treated successfully with conversion to hemodialysis in a chronic renal failure patient on CAPD treatment / 대한내과학회지

Continuous ambulatory peritoneal dialysis(CAPD) is now the most important and effective therapeutic modality as well as hemodialysis(HD) and renal transplantation in patients with chronic renal failure. It is frequently recommended to diabetic renal failure patients because of poor, athersclerotic vascularity of them. Hyperglycemia and obesity are not uncommon complications of CAPD therapy. But there were only few reports of very severe hyperglycemia or hyperosmolar coma in CRF patients on CAPD therapy, especially with 7% dextrose CAPD dialysate in foreign countries in the past. Moreover, no specific management for hyperosmolar coma is established in those situations yet. In Korea, only three cases of hyperosmolar coma in non diabetic renal failure patient on CAPD therapy have been reported in one case report. And only one case among them whose CAPD therapy was changed to HD survived. Authors also experienced a case of diabetic hyperosmolar coma treated successfully with conversion to HD in chronic renal failure patient on CAPD therapy. So we report this case with a review of literature. Taken together with this case and review of literature, changing CAPD therapy to HD is regarded to be an important part of treatment when hyperosmolar coma develops in chronic renal failure patients.