Type 2 Diabetes Complicated With Hyperosmolar Hyperglycemic State and Central Diabetes Insipidus: A Case Report

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  • Hirasawa Reiko
    Department of Internal Medicine, Kudanzaka Hospital
  • Nishitani Rie
    Department of Diabetes, Endocrinology and Metabolism, Tokyo Kyosai Hospital
  • Ashidate Keiko
    Department of Internal Medicine, Kudanzaka Hospital
  • Kawamura Mitsunobu
    Department of Endocrinology and Metabolism, Tokyo Teishin Hospital
  • Yamada Tetsuya
    Department of Molecular Endocrinology and Metabolism, Tokyo Medical and Dental University

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  • 高浸透圧高血糖状態を契機に中枢性尿崩症と診断された2型糖尿病の1例

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Abstract

<p>A 62-year-old man was admitted with consciousness disturbance one month after influenza virus infection. He had polyuria and polydipsia, which had persisted for 6 months, and had already been diagnosed with type 2 diabetes. The laboratory tests on admission revealed the following: blood glucose 905 mg/dL, HbA1c 13 %, Na 171 mEq/L and serum osmolality 415 mOsm/kgH2O. He was diagnosed with a hyperosmolar hyperglycemic state (HHS) and treated with a large volume of fluids and insulin infusion. However, even after his blood glucose level normalized, polyuria and hypernatremia persisted, and his urine osmolality was low. We diagnosed diabetes insipidus based on the findings of brain MRI (T1-weighted image), a hypertonic saline infusion test, and an arginine vasopressin test. We experienced a case involving a patient with type 2 diabetes who developed HHS after influenza infection and was diagnosed with complications of CDI during treatment. If polyuria persists after HHS treatment, CDI complications should also be suspected.</p>

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