Overview of diabetes.

The number of people with diabetes is growing to epidemic proportions in the United States. There is a great deal of research on the evolving understanding of the pathogenesis of diabetes as compared to normoglycemia. The diagnostic criteria for diabetes have become streamlined to more appropriately and accurately diagnose the disease. There are millions of people who have diabetes, but do not know it. It is essential that appropriate screening be performed to make a diagnosis in order to delay or prevent the complications from occurring. The complications of diabetes have implications for the increasing number of people with the diagnosis who are hospitalized and how they are treated. There are specific methods for recognition and treatment of both acute and chronic complications in the hospitalized patent with diabetes. Managing blood glucose control is essential for favorable outcomes.

[The role of serum osmolality monitoring in patients with severe intracranial lesion].

We dynamically determined serum osmolality in 1379 patients with severe intracranial lesion for 2843 times between January 1992 and July 1995. Using auto-control and after abandoned osmolality related interference factors we obtained the following results. Quantitative correlation analysis on the level of serum osmolality, intracranial pressure and the dose of mannitol showed that there was a negative correlation between the level of serum osmolality and intracranial pressure, while a positive correlation existed between the intracranial pressure and the dose of mannitol. The reasonable dose of mannitol was that which elevated the level of serum osmolality some 15-20 mOsm/kgH2O than its normal upper limit. The level of serum osmolality increesed to raised up 20-30 mOsm/kgH2O after administration of a single dose of mannitol. Complication increased with the increased level of osmolality of 300 mOsm/kgH2O, a warning level. An elevation of osmolality over 320 mOsm/kgH2O was considered the critical level for developing acute renal failure. The level of over 330 mOsm/kg H2O was another warning level for inducing nonketotic hyperosmotic diabetic coma. The efficious duration of mannitol, two different ways of diminishing or withdrawing the dose of mannitol, and the more safer velocity for correcting the state of hyperosmolality were also discussed. We conclude that to monitor the dynamic change of serum osmolality from time to time is of great help in lowering the incidence and mortality of hyperosmotic complications. Serum osmolality monitoring plays an important role in making fluid balance and compromizing the contradiction between dehydration and infusion as well as prevention and therapy of hyperosmotic complications, and outcome estimation as well.

Coma hiperglicémico, hiperosmolar, no cetósico: realidad del servicio de medicina adultos del hospital Gustavo Fricke de Viña de Mar 1984-1993 / Hyperglycemic, hyperosmolar, nonketotic coma: reality of the adult medicine service at Gustavo Fricke Hospital in Viña del Mar

Se revisaron retrospectivamente las fichas clínicas de 16 pacientes egresados del Hospital "Gustavo Fricke", entre 1984 y 1993, con el diagnóstico de coma hiperglicémico hiperosmolar no cetósico; a fin de explotar y describir la experiencia del centro asistencial en dicha patología. Se observó una mayor prevalencia en pacientes del sexo femenino y añosos. El antecedente diabético estuvo presente en aproximadamente dos tercios de la muestra. Dentro de los factores precipitantes destacan los cuadros infecciosos (81,2 por ciento). Resalta una hiperglicemia promedio de 723 mgr por ciento y una osmolaridad plasmática promedio de 369,4 mOsm/lt. En el período estudiado de nueve años, sólo logró detectarse 16 casos de esta complicación diabética; sobresaliendo su mortalidad (50 por ciento), mayor que lo expuesto en la literatura

Hyperosmolar nonketotic coma: prevention, diagnosis, and treatment.

With the multi-faceted approach to head and neck cancer today, maintaining caloric intake by long-term enteral hyperalimentation is commonplace. Along with the tremendous advantages of this form of nutrition, the disadvantage of hyperosmolar nonketotic diabetic acidotic coma is present. Mortality rates are quoted from 40% to 70% according to the literature reviewed. Therefore, prevention is the best form of treatment. The cause, diagnosis, and treatment will be discussed.

Avoidance of surgical hyperglycemia in diabetic patients.

Strict intraoperative glucose level control was accomplished with constant low-dose glucose infusion of 100 mg/kg/hr and variable infusion rates of insulin to control serum glucose levels as follows: 20 units/hr for serum glucose levels greater than 200 mg/dL, 1 unit/hr for levels between 80 and 200 mg/dL, and no insulin for levels less than 80 mg/dL. Using this technique, eight diabetic patients with serum glucose levels greater than 250 mg/dL before surgery had their serum glocose levels brought rapidly under control (ie, glucose level less than 200 mg/dL), which continued postoperatively.