BACKGROUND Diabetic ketoacidosis(DKA)and hyperglycemic hyperosmolar state(HHS)are common acute complications of diabetes mellitus with a high risk of mortality.When combined with hypernatremia,the complications can be...BACKGROUND Diabetic ketoacidosis(DKA)and hyperglycemic hyperosmolar state(HHS)are common acute complications of diabetes mellitus with a high risk of mortality.When combined with hypernatremia,the complications can be even worse.Hypernatremia is a rarely associated with DKA and HHS as both are usually accompanied by normal sodium or hyponatremia.As a result,a structured and systematic treatment approach is critical.We discuss the therapeutic approach and implications of this uncommon presentation.CASE SUMMARY A 62-year-old man with no known past medical history presented to emergency department with altered mental status.Initial work up in emergency room showed severe hyperglycemia with a glucose level of 1093 mg/dL and severe hypernatremia with a serum sodium level of 169 mEq/L.He was admitted to the intensive care unit(ICU)and was started on insulin drip as per DKA protocol.Within 12 h of ICU admission,blood sugar was 300 mg/dL.But his mental status didn’t show much improvement.He was dehydrated and had a corrected serum sodium level of>190 mEq/L.As a result,dextrose 5%in water and ringer's lactate were started.He was also given free water via an nasogastric(NG)tube and IV Desmopressin to improve his free water deficit,which improved his serum sodium to 140 mEq/L.CONCLUSION The combination of DKA,HHS and hypernatremia is rare and extremely challenging to manage,but the most challenging part of this condition is selecting the correct type of fluids to treat these conditions.Our case illustrates that desmopressin and free water administration via the NG route can be helpful in this situation.展开更多
Radio and television outfits constitute a subset of the mass media belonging specifically to the broadcast system, and vitally provide information useful for development （among others） to its adherents, consumers, a...Radio and television outfits constitute a subset of the mass media belonging specifically to the broadcast system, and vitally provide information useful for development （among others） to its adherents, consumers, and audiences. Health reporting or health news is an aspect of health communication through which the audiences are informed of all matters relating to their total well-being. In this paper, the authors investigated news reporting among broadcast outfits in Lagos-Nigeria as a measure to monitor or watchdog and report the reporter to his clients. The investigation was in two parts： One looked at his strategies in covering and reporting health in the environment; while the other examined news bulletins to subject its health news to a content analysis. The study revealed that health is a neglected concern in broadcast reporting with trigger or vulture approach/practice among broadcast outfits.展开更多
文摘BACKGROUND Diabetic ketoacidosis(DKA)and hyperglycemic hyperosmolar state(HHS)are common acute complications of diabetes mellitus with a high risk of mortality.When combined with hypernatremia,the complications can be even worse.Hypernatremia is a rarely associated with DKA and HHS as both are usually accompanied by normal sodium or hyponatremia.As a result,a structured and systematic treatment approach is critical.We discuss the therapeutic approach and implications of this uncommon presentation.CASE SUMMARY A 62-year-old man with no known past medical history presented to emergency department with altered mental status.Initial work up in emergency room showed severe hyperglycemia with a glucose level of 1093 mg/dL and severe hypernatremia with a serum sodium level of 169 mEq/L.He was admitted to the intensive care unit(ICU)and was started on insulin drip as per DKA protocol.Within 12 h of ICU admission,blood sugar was 300 mg/dL.But his mental status didn’t show much improvement.He was dehydrated and had a corrected serum sodium level of>190 mEq/L.As a result,dextrose 5%in water and ringer's lactate were started.He was also given free water via an nasogastric(NG)tube and IV Desmopressin to improve his free water deficit,which improved his serum sodium to 140 mEq/L.CONCLUSION The combination of DKA,HHS and hypernatremia is rare and extremely challenging to manage,but the most challenging part of this condition is selecting the correct type of fluids to treat these conditions.Our case illustrates that desmopressin and free water administration via the NG route can be helpful in this situation.
文摘Radio and television outfits constitute a subset of the mass media belonging specifically to the broadcast system, and vitally provide information useful for development （among others） to its adherents, consumers, and audiences. Health reporting or health news is an aspect of health communication through which the audiences are informed of all matters relating to their total well-being. In this paper, the authors investigated news reporting among broadcast outfits in Lagos-Nigeria as a measure to monitor or watchdog and report the reporter to his clients. The investigation was in two parts： One looked at his strategies in covering and reporting health in the environment; while the other examined news bulletins to subject its health news to a content analysis. The study revealed that health is a neglected concern in broadcast reporting with trigger or vulture approach/practice among broadcast outfits.
