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A hyperglycaemic hyperosmolar state in a young child: diagnostic insights from a quantitative analysis.
Carlotti, A P C P; Bohn, D; Jankiewicz, N; Kamel, K S; Davids, M R; Halperin, M L.
Afiliación
  • Carlotti AP; Hospital das Clinicas, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
QJM ; 100(2): 125-37, 2007 Feb.
Article en En | MEDLINE | ID: mdl-17277319
This teaching exercise demonstrates how the application of principles of physiology can identify the cause of a severe degree of hyperglycaemia (plasma glucose concentration 80 mmol/l) in a very young patient with newly diagnosed diabetes mellitus, determine whether the patient has diabetic ketoacidosis, and highlight the potential risks for this patient on admission and during initial therapy. A consultation with Professor McCance was sought to determine whether this patient had an unusual degree of 'insulin resistance'. There were also uncertainties regarding the acid-base diagnosis. The patient did not appear to have an important degree of metabolic acidosis as judged from his pH of 7.39 and plasma bicarbonate concentration of 20 mmol/l in arterial blood; hence the diagnostic impression was that he had a hyperglycaemic hyperosmolar state. However, his plasma anion gap was significantly elevated, and remained so for 60 h, despite the administration of insulin. Issues in management concerning the basis for this severe degree of hyperglycaemia and how to minimize the risk of developing cerebral oedema are addressed. The missing links in this interesting story emerge during a discussion between the medical team and their mentor, Professor McCance.
Asunto(s)
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Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Cetoacidosis Diabética / Hiperglucemia Tipo de estudio: Diagnostic_studies / Etiology_studies / Prognostic_studies / Risk_factors_studies Límite: Humans / Infant / Male Idioma: En Revista: QJM Asunto de la revista: MEDICINA Año: 2007 Tipo del documento: Article País de afiliación: Brasil
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Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Cetoacidosis Diabética / Hiperglucemia Tipo de estudio: Diagnostic_studies / Etiology_studies / Prognostic_studies / Risk_factors_studies Límite: Humans / Infant / Male Idioma: En Revista: QJM Asunto de la revista: MEDICINA Año: 2007 Tipo del documento: Article País de afiliación: Brasil