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
A hypernatremia severity is often associated with a poor prognosis, especially if it is associated with multiple organ failure. In a country with very limited resources, the prognosis may be favorable in the absence o...A hypernatremia severity is often associated with a poor prognosis, especially if it is associated with multiple organ failure. In a country with very limited resources, the prognosis may be favorable in the absence of renal replacement. We report the case of a 63 years old woman, hypertensive and diabetic, admitted to the ICU for unconsciousness. Clinically, neurological examination notes a Glasgow of 8/15 (Y2, V2, M4) and a left hemiplegia. Temperature was 39°C. Diuresis was 100 ml during the first 24 hours. Blood pressure was 90/60 mmHg, tachycardia at 133/min. Cardiac auscultation is normal. Vascular axes were weakly perceptible. Oxygen saturation was 95%. The skin examination notes a dry skin and mucous membranes, a flattening of the superficial veins, sunken eyes and a persistent skin fold. There is no hepatomegaly or splenomegaly, or jaundice. Biological point of view note natremia: 176 mmol/L;osmolarity: 390 mosmol/kg;creatinin: 300 μmol/L;glycemia > 6 g/L;transaminases 217 UI. Diagnostics: malignant hypernatremia with a high plasma osmolarity associated with an acute anuric renal failure, hydro electrolytic disorders, an abnormal liver function, a fever of central origin and a stroke. The treatment consisted of a correction of the electrolyte disorders by infusion of isotonic and hypotonic fluids with insulin. In a country with very limited resources, the severe hypernatremia prognosis associated with anuric acute renal failure may be favorable in the absence of renal replacement.展开更多
A man with past lithium use for more than 15 years, but off lithium for two years and not carrying the diagnosis of diabetes mellitus or nephrogenic diabetes insipidus(NDI), presented with coma and hyperglycemic hyper...A man with past lithium use for more than 15 years, but off lithium for two years and not carrying the diagnosis of diabetes mellitus or nephrogenic diabetes insipidus(NDI), presented with coma and hyperglycemic hyperosmolar state(HHS). Following correction of HHS, he developed persistent hypernatremia accompanied by large volumes of urine with low osmolality and no response to desmopressin injections. Urine osmolality remained < 300 m Osm/kg after injection of vasopressin. Improvement in serum sodium concentration followed the intake of large volumes of water plus administration of amiloride and hydrochlorothiazide. Severe hyperglycemia may trigger symptomatic lithium-induced NDI years after cessation of lithium therapy. Patients with newonset diabetes mellitus who had been on prolonged lithium therapy in the past require monitoring of their serum sodium concentration after hyperglycemic episodes regardless of whether they do or do not carry the diagnosis of NDI.展开更多
Abstract Objective To investigate the therapeutic effect of hypertonic saline (HS) and hypertonic saline with taurine (HST) hemorrhagic shock and hemorrhagic shock with hypernatremia rats. Methods Hypern...Abstract Objective To investigate the therapeutic effect of hypertonic saline (HS) and hypertonic saline with taurine (HST) hemorrhagic shock and hemorrhagic shock with hypernatremia rats. Methods Hypernatremic dehydration and hemorrhagic shock models were produced by Trachtma's and Krausz's methods in Sprague Dawley rats. Hemorrhagic changes of mean arterial blood pressure (MABP), left ventricular end diastolic pressure (LVEDP), ±dp/dtmax and heart rate (HR) were registered on polygraph. Plasma Na +, urea lactate and taurine content were assayed. Results After treatment with HS, the hemodynamic changes of hemorrhagic shock rats were significantly alleviated, and tissue fluid redistributed. When the hemorrhagic shock animals were treated with HS containing taurine (HST), in comparison with HS treatment, the hemodynamic improvement and hemodilution were more obvious. When the hemorrhagic animals complicated with hypernatremia were treated with HS, the symptoms of dehydration and shock further deteriorated, when the hemorrhage with hypernatremia animals were treated with an infusion of HST, the symptoms of dehydration and shock were significantly ameliorated. Conclusion The therapeutic effect of HS with taurine is obviously better than HS alone. So when hemorrhagic shock was complicated with hypernatremia, HS with taurine is recommended in stead of HS alone.展开更多
Sodium homeostasis disorder is one of the most common abnormal symptoms of elderly patients in intensive care unit(ICU),which may lead to physiological disorders of many organs.The current prediction of serum sodium i...Sodium homeostasis disorder is one of the most common abnormal symptoms of elderly patients in intensive care unit(ICU),which may lead to physiological disorders of many organs.The current prediction of serum sodium in ICU is mainly based on the subjective judgment of doctors’experience.This study aims at this problem by studying the clinical retrospective electronic medical record data of ICU to establish a machine learning model to predict the short-term serum sodium value of ICU patients.The data set used in this study is the open-source intensive care medical information set Medical Information Mart for Intensive Care(MIMIC)-IV.The time point of serum sodium detection was selected from the ICU clinical records,and the ICU records of 25risk factors related to serum sodium were extracted from the patients within the first 12 h for statistical analysis.A prediction model of serum sodium value within 48 h was established using a feedforward neural network,and compared with previous methods.Our research results show that the neural network learning model can predict the development of serum sodium in patients using physiological indicators recorded in clinical electronic medical records within 12 h,and has better prediction effect than the serum sodium formula and other machine learning models.展开更多
目的：探索脓毒症患者发生高钠血症的危险因素，及合并高钠血症对脓毒症患者预后的影响。方法通过使用单因素以及多因素Logistic回归分析来明确脓毒症患者10个危险因素与合并高钠血症的关系，包括年龄、性别、急性生理与慢性健康状况评...目的：探索脓毒症患者发生高钠血症的危险因素，及合并高钠血症对脓毒症患者预后的影响。方法通过使用单因素以及多因素Logistic回归分析来明确脓毒症患者10个危险因素与合并高钠血症的关系，包括年龄、性别、急性生理与慢性健康状况评分Ⅱ（ APACHEⅡ评分）、C反应蛋白（ CRP）水平等；同时，比较高钠血症组与非高钠血症组28 d死亡率、住院时间等预后指标。结果 APACHEⅡ评分是脓毒症患者发生高钠血症的独立危险因素（ OR 1．15；95％C I 1．022-1．294）；高钠血症的脓毒症患者住院时间以及机械通气时间明显延长，死亡率明显升高。结论 APACHEⅡ评分是预测脓毒症患者发生高钠血症的独立危险因素，同时与未发生高钠血症的患者比较，合并高钠血症的患者临床预后差。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A hypernatremia severity is often associated with a poor prognosis, especially if it is associated with multiple organ failure. In a country with very limited resources, the prognosis may be favorable in the absence of renal replacement. We report the case of a 63 years old woman, hypertensive and diabetic, admitted to the ICU for unconsciousness. Clinically, neurological examination notes a Glasgow of 8/15 (Y2, V2, M4) and a left hemiplegia. Temperature was 39°C. Diuresis was 100 ml during the first 24 hours. Blood pressure was 90/60 mmHg, tachycardia at 133/min. Cardiac auscultation is normal. Vascular axes were weakly perceptible. Oxygen saturation was 95%. The skin examination notes a dry skin and mucous membranes, a flattening of the superficial veins, sunken eyes and a persistent skin fold. There is no hepatomegaly or splenomegaly, or jaundice. Biological point of view note natremia: 176 mmol/L;osmolarity: 390 mosmol/kg;creatinin: 300 μmol/L;glycemia > 6 g/L;transaminases 217 UI. Diagnostics: malignant hypernatremia with a high plasma osmolarity associated with an acute anuric renal failure, hydro electrolytic disorders, an abnormal liver function, a fever of central origin and a stroke. The treatment consisted of a correction of the electrolyte disorders by infusion of isotonic and hypotonic fluids with insulin. In a country with very limited resources, the severe hypernatremia prognosis associated with anuric acute renal failure may be favorable in the absence of renal replacement.
文摘A man with past lithium use for more than 15 years, but off lithium for two years and not carrying the diagnosis of diabetes mellitus or nephrogenic diabetes insipidus(NDI), presented with coma and hyperglycemic hyperosmolar state(HHS). Following correction of HHS, he developed persistent hypernatremia accompanied by large volumes of urine with low osmolality and no response to desmopressin injections. Urine osmolality remained < 300 m Osm/kg after injection of vasopressin. Improvement in serum sodium concentration followed the intake of large volumes of water plus administration of amiloride and hydrochlorothiazide. Severe hyperglycemia may trigger symptomatic lithium-induced NDI years after cessation of lithium therapy. Patients with newonset diabetes mellitus who had been on prolonged lithium therapy in the past require monitoring of their serum sodium concentration after hyperglycemic episodes regardless of whether they do or do not carry the diagnosis of NDI.
文摘Abstract Objective To investigate the therapeutic effect of hypertonic saline (HS) and hypertonic saline with taurine (HST) hemorrhagic shock and hemorrhagic shock with hypernatremia rats. Methods Hypernatremic dehydration and hemorrhagic shock models were produced by Trachtma's and Krausz's methods in Sprague Dawley rats. Hemorrhagic changes of mean arterial blood pressure (MABP), left ventricular end diastolic pressure (LVEDP), ±dp/dtmax and heart rate (HR) were registered on polygraph. Plasma Na +, urea lactate and taurine content were assayed. Results After treatment with HS, the hemodynamic changes of hemorrhagic shock rats were significantly alleviated, and tissue fluid redistributed. When the hemorrhagic shock animals were treated with HS containing taurine (HST), in comparison with HS treatment, the hemodynamic improvement and hemodilution were more obvious. When the hemorrhagic animals complicated with hypernatremia were treated with HS, the symptoms of dehydration and shock further deteriorated, when the hemorrhage with hypernatremia animals were treated with an infusion of HST, the symptoms of dehydration and shock were significantly ameliorated. Conclusion The therapeutic effect of HS with taurine is obviously better than HS alone. So when hemorrhagic shock was complicated with hypernatremia, HS with taurine is recommended in stead of HS alone.
基金supported by the National Natural Science Foundation of China(No.12345678)。
文摘Sodium homeostasis disorder is one of the most common abnormal symptoms of elderly patients in intensive care unit(ICU),which may lead to physiological disorders of many organs.The current prediction of serum sodium in ICU is mainly based on the subjective judgment of doctors’experience.This study aims at this problem by studying the clinical retrospective electronic medical record data of ICU to establish a machine learning model to predict the short-term serum sodium value of ICU patients.The data set used in this study is the open-source intensive care medical information set Medical Information Mart for Intensive Care(MIMIC)-IV.The time point of serum sodium detection was selected from the ICU clinical records,and the ICU records of 25risk factors related to serum sodium were extracted from the patients within the first 12 h for statistical analysis.A prediction model of serum sodium value within 48 h was established using a feedforward neural network,and compared with previous methods.Our research results show that the neural network learning model can predict the development of serum sodium in patients using physiological indicators recorded in clinical electronic medical records within 12 h,and has better prediction effect than the serum sodium formula and other machine learning models.
文摘目的：探索脓毒症患者发生高钠血症的危险因素，及合并高钠血症对脓毒症患者预后的影响。方法通过使用单因素以及多因素Logistic回归分析来明确脓毒症患者10个危险因素与合并高钠血症的关系，包括年龄、性别、急性生理与慢性健康状况评分Ⅱ（ APACHEⅡ评分）、C反应蛋白（ CRP）水平等；同时，比较高钠血症组与非高钠血症组28 d死亡率、住院时间等预后指标。结果 APACHEⅡ评分是脓毒症患者发生高钠血症的独立危险因素（ OR 1．15；95％C I 1．022-1．294）；高钠血症的脓毒症患者住院时间以及机械通气时间明显延长，死亡率明显升高。结论 APACHEⅡ评分是预测脓毒症患者发生高钠血症的独立危险因素，同时与未发生高钠血症的患者比较，合并高钠血症的患者临床预后差。
