Five Cases of Mixed Hyperosmolar Hyperglycemia and Diabetic Ketoacidosis

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  • 著明な高浸透圧高血糖症候群と中等度糖尿病性ケトアシドーシスを合併した2型糖尿病5症例の臨床的検討
  • 症例報告 著明な高浸透圧高血糖症候群と中等度糖尿病性ケトアシドーシスを合併した2型糖尿病5症例の臨床的検討
  • ショウレイ ホウコク チョメイナ コウシントウアツ コウケットウ ショウコウグン ト チュウトウド トウニョウビョウセイ ケトアシドーシス オ ガッペイシタ 2ガタ トウニョウビョウ 5 ショウレイ ノ リンショウテキ ケントウ

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We report the cases of five Japanese type 2 diabetes patients with mixed hyperosmolar hyperglycemic syndrome (HHS) and diabetic ketoacidosis (DKA). Their mean age was 43.6 years, their plasma glucose 1,800 mg/dl, HbA1c 13.4%, serum osmolarity 419 Osm/kgH2O, and arterial pH on admission 7.17. They had relatively minor changes in consciousness levels. Two patients had schizophrenia. Three had a history of diabetes, of whom two were not being treated. Precipitating causes were common cold and carbonated drinks. Onset of mental status change to hospital admission was a mean 2.6 days. Major inpatient complications were candidiasis, kidney failure requiring temporary hemodialysis, pulmonary embolism, rhabdomyolysis, sepsis, and stress-induced cardiomyopathy. The average hospital stay was 43.4 days. One patient required insulin therapy and two were discharged on oral agents. Conclusions: DKA and HHS were not mutually exclusive. The number of these mixed cases is expected to increase with the growing high-risk population. Maintaining good glycemic control in such high-risk patients is thus critical in preventing serious, costly complications.

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