ABSTRACT
BACKGROUND: Hyperosmolar hyperglycaemic state (HHS) is a syndrome that occurs in patients with type 2 diabetes mellitus (T2DM) and is comparable to diabetic ketoacidosis (DKA) seen in patients with type 1 diabetes. For a general practitioner working in a rural emergency department, recognition of HHS in a patient presenting with the triad of severe dehydration, hyperglycaemia and hyperosmolality is important to guide management and plan for disposition. OBJECTIVES: This article reviews the hyperglycaemic states that can occur in patients with T2DM. The reasons for the biochemical derangements in both HHS and DKA are outlined, with a focus on the recognition and management of HHS. DISCUSSION: Knowledge of the pathophysiology that influences HHS helps understand of its clinical presentation and treatment. HHS has a high mortality rate (520%), and having access to clinical guidelines from a referring hospital is useful to guide early management strategies.
Subject(s)
Diabetes Mellitus, Type 2/complications , Hyperglycemia/etiology , Blood Glucose/analysis , Diabetes Mellitus, Type 2/blood , Diabetes Mellitus, Type 2/physiopathology , Diabetic Ketoacidosis/blood , Diabetic Ketoacidosis/etiology , Diabetic Ketoacidosis/physiopathology , Humans , Hyperglycemia/blood , Hyperglycemia/physiopathology , Hyperglycemic Hyperosmolar Nonketotic Coma/blood , Hyperglycemic Hyperosmolar Nonketotic Coma/etiology , Hyperglycemic Hyperosmolar Nonketotic Coma/physiopathology , Male , Middle AgedABSTRACT
BACKGROUND: There is a known increased risk of vitamin D deficiency in darker skinned people living in in temperate latitudes, but there is limited literature specifically on Australian Aboriginal women and their vitamin D status in pregnancy. METHODS: This paper reports the findings of a prospective cohort study comparing vitamin D levels in a group of pregnant Aboriginal women with a group of pregnant non-Aboriginal women living in the same town in Western Australia. RESULTS: Aboriginal patients from the Aboriginal Community Controlled Health Service (ACCHS) had lower serum vitamin D levels (mean 46.7, SD 21.7 nmol/L), compared with their non-Aboriginal women (mean 65.4, SD 18.4 nmol/L, P CONCLUSION: We believe this is the first study to compare vitamin D levels in pregnant Aboriginal women with non-Aboriginal women living in the same community at temperate latitude.
