Causes de décès en milieu de réanimation polyvalente au Centre Hospitalier Universitaire Analakininina, Madagascar / Causes of death in the intensive care unit Of the Analakininina teaching hospital, Madagascar

Background: Intensive Care Unit unit is taking care the serious patients whose vital prognosis is engaged. Death remains the main fear of those patients who are admitted to intensive care. The main objective of our study was to identify the causes of death in the intensive care unit at the Analakininina teaching hospital, Toamasina, madagascar. Methods: This was a descriptive, retrospective study carried out from January 1, 2019 to June 30, 2019. Results: We had identified 110 cases of death with a high male prevalence and a sex ratio of 1.75. The average age was 48.73 +/- 17.60 years. The main reason for admission was disturbance of consciousness in 63.64% of cases with 24.45% of severe coma. Regarding the causes of death, a total of 25 diagnosis were made. The shock states represented 30% of the causes of death of which 69% were septic, 18% cardiogenic and 15.15% hypovolemic. Next, stroke accounted for 28%, cerebral malaria 7.27% and diabetic coma accounted for 5.45% of causes of death. The average length of hospital stay was 1.91 days. Conclusion: Our study provides a better understanding of the causes of death of patients in the intensive care unit. These data can point towards initiatives to improve the quality of care

Short-term Effect of Ambient Air Pollution on Emergency Department Visits for Diabetic Coma in Seoul, Korea / 예방의학회지

OBJECTIVES: A positive association between air pollution and both the incidence and prevalence of diabetes mellitus (DM) has been reported in some epidemiologic and animal studies, but little research has evaluated the relationship between air pollution and diabetic coma. Diabetic coma is an acute complication of DM caused by diabetic ketoacidosis or hyperosmolar hyperglycemic state, which is characterized by extreme hyperglycemia accompanied by coma. We conducted a time-series study with a generalized additive model using a distributed-lag non-linear model to assess the association between ambient air pollution (particulate matter less than 10 μm in aerodynamic diameter, nitrogen dioxide [NO2], sulfur dioxide, carbon monoxide, and ozone) and emergency department (ED) visits for DM with coma in Seoul, Korea from 2005 to 2009. METHODS: The ED data and medical records from the 3 years previous to each diabetic coma event were obtained from the Health Insurance Review and Assessment Service to examine the relationship with air pollutants. RESULTS: Overall, the adjusted relative risks (RRs) for an interquartile range (IQR) increment of NO2 was statistically significant at lag 1 (RR, 1.125; 95% confidence interval [CI], 1.039 to 1.219) in a single-lag model and both lag 0-1 (RR, 1.120; 95% CI, 1.028 to 1.219) and lag 0-3 (RR, 1.092; 95% CI, 1.005 to 1.186) in a cumulative-lag model. In a subgroup analysis, significant positive RRs were found for females for per-IQR increments of NO2 at cumulative lag 0-3 (RR, 1.149; 95% CI, 1.022 to 1.291). CONCLUSIONS: The results of our study suggest that ambient air pollution, specifically NO2, is associated with ED visits for diabetic coma.

Estados hiper e hipoglicêmicos agudos: conduta atual / Acute hyper and hypoglycaemic states: current conduct

Os estados hiperglicêmicos e hipoglicêmicos agudos são exemplos das mais comuns emergências médicas com que nos deparamos no campo das alterações do metabolismo. Os estados hiperglicêmicos agudos compreendem a cetoacidose diabética e o coma hiperosmolar hiperglicêmico não cetótico. Neste artigo, analisamos essas condições hiperglicêmicas, que representam um desafio para o clínico e o médico generalista que trabalham no terreno nas emergências médicas

The acute hypoglycemic and hyperglycemic situations are examples of the most common medical emergencies that we face in the field of metabolic disorders. The acute hyperglycemic situations include diabetic ketoacidosis and hyperosmolar hyperglycemic coma hyperosmolar nonketotic. In this article, we analyze these two hyperglycemic conditions that represent a challenge to the clinician and general practitioner working in the field in medical emergencies

Curso de atualização em emergências médicas: aula 17: emergência em diabéticos / Course of updating in medical emergencies: class 17: emergency in diabetics

A cetoacidose diabética e o estado hiperosmolar hiperglicêmico não cetótico são complicações hiperglicêmicas agudas do diabetes mellitus e representam um desafio para o clínico que trabalha no terreno das emergências médicas. A cetoacidose diabética pode ser a manifestação inicial ou resultar de intercorrências havidas em pacientes com diabetes tipo 1. Além disso, pode se instalar em pacientes diabéticos tipo 2 submeticos a situações de extrema gravidade, tais como sepse. O coma hiperosmolar hiperglicêmico não cetótico costuma acometer portadores de diabetes tipo 2. Tais complicações trazem risco à vida do paciente diabético, com elevada taxa de mortalidade. Estas e outras emergências diabéticas são abordadas no presente artigo, com ênfase em diagnóstico e tratamento.

Diabetic ketoacidosis and nonketotic hyperosmolar hyperglycemic syndrome are challenging metabolic complications of diabetes mellitus, especially in the setting of the emergency department. Diabetic ketoacidosis can be the first clinical manifestation of type 1 diabetes or result of intercurrent events in someone already diagnosed with type 1 diabetes. Nonketotic hyperosmolar hyperglycemic coma is more frequently associated with type 2 diabetes. Both complications are lefe-threatening and the mortality rate is high. Management of this and other acute complications of diabetes are discussed, emphasizing diagnosis and treatment.

Hyperosmolar hyperglycemic non ketotic coma and rhabdomyolysis; an uncommon clinical encounter

Rhabdomyolysis is usually attributed to trauma. However there is an association of rhabdomyolysis with hyperosmolar states. Recognition of this association will enable better management of the patient and reduce the burden on the care taker by preventing the onset of complications that can prove fatal. It is also important to realise that hyperosmolar coma can be the presenting complaint of a diabetic seeking medical attention for the first time

Coma metabólico / Methabolic coma

Coma pode ser definido como um estado de não-responsividade e não-reatividade do organismo, e o seu diagnóstico é feito quando temos uma Escala de Coma de Glasgow menor ou igual a 7. De acordo com a literatura médica, aproximadamente 60 por cento dos casos de coma têm origem em desordens metabólicas, que levam a alterações no suprimento de metabólitos ou modificações da excitabilidade neuronal.

Presentation and precipitating factors of diabetic Ketoacidosis in children

Diabetes mellitus is a metabolic disorder caused by absolute or relative deficiency of insulin. It is the most common metabolic disorder of childhood and is caused by deficiency of insulin [type 1]. Its prevalence is 1 per 500-600 children. The incidence is 1.2-1.9 cases per 1000 children. The complications of diabetes are multiple and severe. Immediate complications include Diabetic Ketoacidosis [DKA] and Coma. 10-30% children present with DKA. The main contributing factor is relative lack of insulin. This occurs when there is increased requirement for insulin due to increased physiological stress as seen in infection, trauma, surgery and psychological stress, etc. [1] To identify the frequency of various presentations of DKA in children. [2] To identify the frequency of various precipitating factors of DKA in children. [3] To correlate the incidence of DKA with age and socioeconomic conditions. A cross-sectional study. JMDCH, January 2004 - October 2004. The convenient sample of 50 histories was collected from pediatric departments of various public and private sector hospitals of Karachi. Results were analyzed using MS Excel 2000. A total of 50 cases were analyzed out of which most of the cases were undiagnosed [64%] and belonged to low socioeconomic group [58%]. Mean age of male patients was significantly lower as compared to females [5.5 +/- 2.31 vs. 7.54 +/- 3.05, p<0.05], while status of hydrogen ion concentration [pH] was significantly lower in females [7.16 +/- 1.46 vs. 7.26 +/- 0.08, p<0.05]. Most frequent presenting complaints were vomiting, abdominal pain, dehydration and respiratory distress [34%]. The most frequent precipitating factor was fever in 17[34%] cases. More than half of the cases are undiagnosed and belong to low socioeconomic group. The level of awareness towards diagnosis of disease increases with the socioeconomic conditions. DKA affects both the genders equally; males being affected at an earlier age group. Most frequent presenting complaints are vomiting, abdominal pain, dehydration and respiratory distress while fever is the chief precipitating factor

A case of rhabdomyolysis developed in patient with thyroid storm / 대한내과학회지

Rhabdomyolysis is defined as skeletal muscle injury with release of muscle cell constituents into the plasma. Trauma and drugs are important causes of rhabdomyolysis and not rarely it is associated with metabolic disorders such as diabetic coma, severe electrolyte disturbances and myxedema coma. There are a few reports about rhabdomyolysis developed in patient with thyroid storm. which is defined as a sudden, life threatening exacerbation of thyrotoxicosis. In this report, we described the case of thyroid storm complicated by rhabdomyolysis.

Subtipos no clásicos de diabetes mellitus / Non classical subtypes of diabetes mellitus

Background: Some adult, obese and diabetic patients, initiate their disease with a severe diabetic ketoacidosis without a precipitating factor and do not require insulin thereafter. These patients are classified as having a non classical diabetes mellitus. Aim: To study the clinical, immunological, genetic and metabolic features of patients with non classical diabetes mellitus. Patients and methods: Ten patients (9 men, aged 45ñ12 years old) with non classical diabetes mellitus were studied. Anti islet and anti glutamic acid decarboxylase antibodies (ICA and anti GAD), HLA DQ a arginine 52 and non aspartic ß57 were measured. Insulin secretion was measured by C peptide after glucagon injection and with the minimal model of Bergman. The latter model was also used to determine insulin sensitivity. Results: Three patients were immunologically classified as type 1, since they had positive ICA or antiGAD antibodies and type 1 genetics (neutral or susceptible HLA DQ a and ß). They had insulin secretion after glucagon stimulus (C peptide ranging from 2.2 to 7.5 pmol/ml), but an almost absent response to a glucose load. They were also insulin resistant (a sensitivity index ranging from 0.05 to 1.67 x 10-4 min/µU x ml). These three cases could be categorized as latent type 1. The other seven patients were ICA negative and antiGAD negative. Five had a susceptible HLA genotype for type 1 diabetes and two were neutral. All had insulin secretion after glucagon stimulation and a variable response to glucose. Six were insulin resistant (sensitivity index ranging from 0.32 to 1.29 x 10-4 min/µU x ml). One patient was insulin sensitive (sensitivity index of 3.83 x 10-4 min/µU x ml). Therefore all these patients were classified as type two diabetics with an atypical debut. Conclusions: Not all diabetics presenting with a severe diabetic ketoacidosis are type I. Among these, there are subjects with a latent type 1 diabetes or with an atypical type 2 diabetes

Neurological emergencies--diabetes management.

Diabetes can affect the nervous system in several ways. Of all the neurological complications of diabetes, peripheral neuropathy is by far the commonest and has been extensively studied. The involvement of central nervous system can be in several forms. The underlying damage may be due to involvement of the large and small cerebral blood vessels as also due to metabolic derangement caused by prolonged hypoglycemia, anoxia or ketoacidosis. The neurological emergencies that occur in diabetes can be: 1) atherothrombotic and lacunar strokes; 2) convulsive disorder in the setting of both hypo and hyperglycemia; 3) coma; 4) cranial neuropathies; and 5) acute proximal muscle weakness. In patients with diabetes, atherothrombotic stroke is associated with poor outcome. Hyperglycemia at the time of stroke is an important risk factor for an adverse outcome than chronic stable diabetic state. Proper management of diabetes in these acute situations is crucial for a better outcome of the underlying disease process.

Cetoacidosis diabetica: a proposito de un caso / Diabetic quetoacidosis: on pourpose of a case

Presentamos un caso de cetoacidois diabética admitido en el Pabellón Británico (Medicina Interna - Endocrinologia) del Hospital de Clínicas Universditario de la ciudad de La Paz, en abril del año en curso. la paciente cursa con una cuadro de diabetes mellitus tipo 2 de tres años de evolución, presentando en varias oportunidades descompensación del cuadro metabólico lo quemotivó su internación. la paciente fue admitida con signos claros de descompensación diabética por un proceso infecciosos de vías urinarias, la evolución fue tórpida a pear de la reposición híbrida adecuada y la insulinoterapia con insulina isofánica, aunque no fue tratada la causa desencadenante. El manejo no fue reglado y se obvió algunos exámenes que hubieran prevenido la complicación que era inminente. El objetivo de la presetne publicación es recordar la fisiopatologí, los factores desencadenantes, las caracterísitcas clínico-laboratoriales, los criterios de diagnostico, la diferenciación de otras patologías que aparentan una cetoacidosis diabética, pero por sobre todo el manejo terapéutico. De ninguna manera pretendemos establecer teglas rígidas, por el contrario la terapia de estas complicaciones debe ser flexible, ya que la modificación de las dosis de insulina, electrolitos y la camtidad de líquido a reponer están en función de la respuesta a la terapia instalada y a os mecanismos intrínsecos de defensa del organismo, de esta manera pretendemos dar guías de orientacion del manejo de estos pacientes cuyas vidad corren riesgo de no ser atendidos con la prontitud y destreza que el caso aconseja. Un tratamietno oportuno, eficiente y adecuado permitirá mantener tassa de mortalidad menores al 5 porciento.

A case of central pontine myelinolysis in uremic patient with peritoneal dialysis / 대한내과학회지

Central pontine myelinolysis (CPM) is a rare syndrome, especially in uremic patients undergoing dialysis. CPM induced by diabetic coma in hemodialysis patients or associated with rapid correction of hyponatremia in peritoneal dialysis patients have been reported. However, its pathogenesis has been unclear. We report a case of CPM in a 67-year-old female uremic patient undergoing continuous ambulatory peritoneal dialysis, who was admitted to our hospital for drowsy mentality. Sodium was normal (140 mEq/L) initially and throughout the entire clinical course. The fasting blood sugar level was 110 mg/dL, serum osmolality 312 mOsm/KgH2O and osmolar gap 9.47. The axial T2-weighted brain MRI showed high signal intensity in the basal pons.

Interação enfermeiro-familiar de paciente com comunicação prejudicada / Impaired communication in interactions between nurses and patients family members

O presente estudo tem por objetivo apresentar a análise de uma interação de enfermeira com familiar de paciente com comunicação prejudicada, tendo por base o referencial teórico do relacionamento interpessoal. A paciente, uma jovem de 20 anos com feto morto, apresentava várias complicações. A interação ocorreu com a tia (mãe de criação) da paciente. Quanto a sua estrutura, esta interação foi diagnóstica, terapêutica e permitiu estabelecer uma proposta de ajuda conjunta. Quanto ao conteúdo foi possível encontrar os pontos de apoio dos familiares e identificar fatos novos para a equipe poder melhorar a assistência à paciente.

Miocardiopatatía diabetica / Diabetic miocardiopathy

Durante mucho tiempo no se sospechaba la existencia de esta entidad clínica, y en la última década se trata de confirmarla gracias a la tecnología recientemente desarrollada. Por eso es que resulta difícil encontrarla en muchos libros, incluso en los exclusivos de Cardiología y Endocrinología, y también con relativa frecuencia en las revistas especializadas