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Steroid-Induced Diabetes Ketoacidosis in an Immune Thrombocytopenia Patient: A Case Report and Literature Review.
Alakkas, Z, Alzaedi, OA, Somannavar, SS, Alfaifi, A
The American journal of case reports. 2020;:e923372
Abstract
BACKGROUND Steroids are used as anti-inflammatory agents, administered for a variety of medical conditions, either as short- or long-term treatment. Steroid use is associated with many adverse effects, including hyperglycemia, but ketoacidosis is rare. CASE REPORT We present the case of a 53-year-old woman who developed diabetic ketoacidosis after administration of methylprednisolone during treatment of immune thrombocytopenic purpura. She did not have diabetes or a family history of diabetes. Steroid-induced hyperglycemia with insulin resistance, lipolysis, and ketogenesis occurred and were likely to have precipitated the ketoacidosis. Blood glucose, blood gases, and urine test results were diagnostic for ketoacidosis. CONCLUSIONS The risk of ketoacidosis and hyperglycemia should be considered in the course of steroid therapy, even without a diagnosis of diabetes, especially in patients who have risk factors for diabetes mellitus including obesity and long-term use of steroids, so that early identification of diabetic ketoacidosis can prevent further morbidity and mortality in chronic patients.
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Clinical manifestation of non-ketotic hyperglycemia chorea: A case report and literature review.
Wang, W, Tang, X, Feng, H, Sun, F, Liu, L, Rajah, GB, Yu, F
Medicine. 2020;(22):e19801
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Abstract
INTRODUCTION Chorea is considered a special complication of diabetes mellitus. Here we report a case of chorea associated with non-ketotic hyperglycemia (NKH). PATIENT CONCERNS The patient was a 79-year-old Asian woman. She had a history of type 2 diabetes mellitus more than 30 years, but with a poor control of blood sugar. She complained of acute onset of right limb involuntary activities, and being admitted to neurology department. DIAGNOSIS The patient was then diagnosed with NKH chorea. INTERVENTIONS Intravenous infusion of insulin was given to reduce blood glucose. Haloperidol was used to control motor symptoms. OUTCOMES Her symptoms improved quickly after treatment. In the past year, the patient's blood sugar was well controlled and her chorea did not recur. LESSONS If there are sudden abnormal movements in patients, in addition to thinking of chorea, hepatolenticular degeneration and other diseases, we should also pay attention to blood sugar, especially in diabetic patients with poor blood sugar control and negative ketone, we should consider the possibility of NKK chorea. CONCLUSIONS NKH chorea is a special complication of diabetes.
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Symptomatic Hyperglycemia in a Patient with Dialysis Ascites.
Vigil, D, Kien, C, Gibb, J, Glew, RH, Tzamaloukas, AH
The American journal of the medical sciences. 2019;(6):512-516
Abstract
An anuric woman with ascites rapidly developed extreme hyperglycemia and seizures after hemodialysis. During development of hyperglycemia, the decrease in serum sodium concentration (Δ[Na]) was nearly twice the value predicted by a formula accounting for the degree of hyperglycemia and the intracellular-to-extracellular volume ratio. The prediction assumed that ascitic fluid is part of the extracellular volume. Potential contributors to the development of seizures include the rapid development of severe hypertonicity, a remote history of seizure disorder and development of dialysis disequilibrium syndrome. Observations in peritoneal dialysis suggest that fluid with sodium concentration lower than in the ascitic fluid is transferred from the abdominal cavity into the blood during rapid development of hyperglycemia. In this case, Δ[Na], which determines the tonicity level expected after correction of hyperglycemia, resulted from exit of both intracellular and ascitic fluid into the extracellular compartment and, therefore, ascitic fluid functions as an extension of the intracellular fluid.
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Hemichorea after hyperglycemia correction: A case report and a short review of hyperglycemia-related hemichorea at the euglycemic state.
Cho, HS, Hong, CT, Chan, L
Medicine. 2018;(10):e0076
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Abstract
RATIONALE Hyperglycemic hemichorea tends to affect elderly patients with type 2 diabetes, women, and the Asian population. The onset of involuntary movement typically occurs at the hyperglycemic state and subsides at the euglycemic state. In this report, we present an unusual case that developed delayed-onset hemichorea after hyperglycemia correction. PATIENT CONCERNS A 70-year-old man was admitted to neurology ward with symptoms of subacute dizziness. Hyperglycemia and high level ketone body was incidentally noted. Hemichorea occurred in his left limbs 2 days after hyperglycemia correction. DIAGNOSES Patient remained conscious, and no other focal neurological deficits were noted while hemichorea occurred. Blood test revealed no contributory cause. Brain magnetic resonance imaging revealed no lesions in the putamen or subthalamus. A diagnosis of probable hyperglycemia-related hemichorea was made. INTERVENTIONS Haloperidol (2 mg, 3 times per day) was prescribed. OUTCOMES Hemichorea improved gradually before discharge and resolved 4 months later. LESSONS Differential diagnosis of hemichorea should include delayed-onset hemichorea after hyperglycemia correction.
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[Clinical characteristics of hemichorea associated with non-ketotic hyperglycemia in 3 patients: case report and literature review].
Hu, Y, Zhou, Y, Yi, F, Yao, L, Xu, H, Zhou, L
Zhong nan da xue xue bao. Yi xue ban = Journal of Central South University. Medical sciences. 2017;(11):1341-1347
Abstract
To investigate the pathophysiology, clinical manifestation and neuroimaging characteristics and therapeutic experiences for hemichore associated with non-ketotic hyperglycemia (HC-NH).
Methods: Clinical data of three patients with HC-NH from Xiangya Hospital, Central South University were analyzed retrospectively, and the related literature was reviewed.
Results: The core clinical features of HC-NH were characterized by acute/subacute onset of hemichorea with non-ketotic hyperglycemia in the elderly females. Radiologic findings associated with HC-NH were characterized by hyperattenuation on computed tomographic (CT) scans and hyperintensity on T1-weighted magnetic resonance imaging (MRI) at unilateral basal ganglion region. Blood glucose control was the foundation of treatment. Dopamine receptor antagonists and benzodiazepine sedative were helpful in controlling hemichorea.
Conclusion: Hemichorea-hemiballismus is a rare complication of nonketotic hyperglycaemia in elderly type 2 diabetes. It is associated with contralateral striatal radiological abnormality and typically T1 hyperintensity on MRI. The pathophysiology of HC-NH is not clear. The prognosis of HC-NH is favorable. Antidiabetic drugs combined with dopamine receptor antagonists can effectively relieve the hemichorea symptoms.
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Cushing's syndrome during pregnancy caused by adrenal cortical adenoma: a case report and literature review.
Wang, W, Yuan, F, Xu, D
Frontiers of medicine. 2015;(3):380-3
Abstract
Cushing's syndrome (CS) during pregnancy is a rare condition with significant maternal and fetal complications. A case of CS during the third trimester of pregnancy secondary to adrenocortical adenoma was reported. Literature review revealed the disadvantages of different treatments in this period. Besides the conservative treatment, surgery is recommended for CS during the third trimester of pregnancy secondary to adrenal adenoma, if an experienced surgeon is available.
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Hypertriglyceridemia and hyperglycemia induced by capecitabine: a report of two cases and review of the literature.
Han, GH, Huang, JX
Journal of oncology pharmacy practice : official publication of the International Society of Oncology Pharmacy Practitioners. 2015;(5):380-3
Abstract
BACKGROUND Capecitabine is a tumor-activated oral fluoropyrimidine used in breast and colorectal cancer. Hypertriglyceridemia associated with this drug has rarely been reported in the literature. METHODS Two patients with colorectal carcinoma who developed capecitabine-induced hypertriglyceridemia (including a patient who developed hyperglycemia concurrently) were described, treatment modalities were discussed, and the literatures were reviewed. RESULTS The first patient, a 43-year-old man, developed hyperlipidemia and hyperglycemia after two cycles of XELOX regimen chemotherapy for colorectal cancer. His triglyceride was 2.47 mmol/L (normal range 0.34-1.7 mmol/L) and total cholesterol was 6.93 mmol/L (normal range 3.12-5.9 mmol/L), while blood glucose was abnormal (fasting blood glucose was 10.58-11.9 mmol/L and 2 h postprandial glucose was 14.5-17.2 mmol/L) and glucose was positive in the urine(3+). The second patient, a 47-year-old woman, developed abnormalities in the lipid profile after the sixth cycle of XELOX regimen chemotherapy for colorectal cancer. Her serum triglyceride was 2.41 mmol/L (normal range 0.34-1.7 mmol/L), while the cholesterol level was 7.73 mmol/L (normal range 3.12-5.9 mmol/L). The profile of lipid improved gradually with reduced doses of capecitabine and was well restored after chemotherapy without any lipid-lowering agents. The Naranjo score for capecitabine-induced hypertriglyceridemia was 9 (definite). An analysis of the underlying pathogenic mechanisms was provided. CONCLUSION It is important of physicians and pharmacists to be aware of the possibility of dyslipidemia, particularly hypertriglyceridemia induced by capecitabine.
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A child with altered sensorium, hyperglycemia, and elevated troponins.
Arora, R, Chiwane, S, Hartwig, E, Kannikeswaran, N
The Journal of emergency medicine. 2014;(2):184-90
Abstract
BACKGROUND Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are potentially life-threatening complications of diabetes mellitus. Although DKA and HHS share similar features, they are distinct clinical entities requiring different treatment measures. OBJECTIVE This case illustrates that the clinical distinction between these two entities can be difficult at times, especially in children who can present with an overlapping picture. CASE REPORT We report an interesting case of a 12-year-old whose initial presentation of diabetes was a mixed picture of hyperosmolar DKA and HHS coma complicated by myocardial strain and acute renal insufficiency. The myocardial strain resolved completely with resolution of the metabolic abnormalities. CONCLUSIONS Emergency physicians should be cognizant of varied presentations of hyperglycemic emergencies in children to initiate appropriate management for better outcomes.
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Occipital seizures induced by hyperglycemia: a case report and review of literature.
Moien-Afshari, F, Téllez-Zenteno, JF
Seizure. 2009;(5):382-5
Abstract
An 83-year-old right-handed male presented with a 2-day history of episodic jerking and "spasms" in the left arm, each lasting approximately 1min, followed by weakness. He also described episodes of flashing colorful lights (green and blue) in his left visual field, not always accompanied by arm jerking, associated with intermittent confusion. His past medical history was significant for type-2 diabetes mellitus. Neurological exam showed an intermittent visual deficit in both eyes, in the inferior fields, mild left upper extremity weakness with brisk reflexes. Several brief episodes of focal motor (clonic) seizure activity involving the left upper limb were observed. Blood glucose was 639mg/dL, with serum osmolarity of 316mosmol/L. Ketoacidosis was absent. Two electrographic seizures from the left occipital region maximum at O1 associated with visual symptoms were recorded. CT head performed on the day of admission was normal. MRI was not done because of a pacemaker. Patient was treated with hydration and insulin and all the neurological symptoms including the seizures disappeared after 24h. We report a patient with clinical and electrographic seizures from the occipital region associated with hyperglycemia. This is a unique complication of hyperglycemia and anecdotal reports of patients with this clinical presentation have been published over the years. Sporadic EEG descriptions have been reported before.
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Rapid overgrowth of a fetus after interruption of insulin therapy in a diabetic woman.
Sugiyama, T, Murabayashi, N, Umekawa, T, Nagao, K, Kamimoto, Y, Sugihara, T, Sagawa, N
Diabetes research and clinical practice. 2008;(2):e9-e11
Abstract
We experienced a case of fetal overgrowth probably due to maternal hyperglycemia following the interruption of insulin therapy in a woman with gestational diabetes mellitus (GDM), probably undiagnosed type 2 diabetes mellitus. A 27-year-old Japanese woman was referred to our center because of GDM at 15 weeks of gestation. During the course of her educational admission, diet control and insulin therapy resulted in favorable blood sugar levels and she was discharged at 17 weeks of gestation. During these periods, fetal growth remained below average at between -1 and -1.5 S.D. After a check-up in the 29th week, she failed to appear for any further appointments. After the onset of labor, at 38 weeks of gestation, she suddenly consulted her former physician who delivered a baby weighing 4852g by cesarean section on the 38th week. A noteworthy point in this case is the growth curve of the fetus. Even if rapid overgrowth is assumed, starting after the time of interruption of insulin at 30 weeks of gestation, fetal weight gain appears to be about 400g per week, suggesting a weight increase at twice the normal rate. This case prompted us to keep in mind that rigid glycemic control will prevent the development of fetal macrosomia in diabetic pregnant women.