[Treatment of acute diabetic metabolic crises in adults (Update 2019) : Hyperglycemic hyperosmolar state and ketoacidotic metabolic disorders].
Kaser Susanne,Sourij Harald,Clodi Martin,Schneeweiß Bruno,Laggner Anton N,Luger Anton
Wiener klinische Wochenschrift
Diabetic ketoacidosis (DKA) and the hyperglycemic hyperosmolar state (HHS) represent potentially life-threatening situations in adults. Therefore, rapid comprehensive diagnostic and therapeutic measures with close monitoring of vital and laboratory parameters are required. The treatment of DKA and HHS is essentially the same and replacement of the mostly substantial fluid deficit with several liters of a physiological crystalloid solution is the first and most important step. Serum potassium concentrations need to be carefully monitored to guide its substitution. Regular insulin or rapid acting insulin analogues can be initially administered as an i.v. bolus followed by continuous infusion. Insulin should be switched to subcutaneous injections only after correction of the acidosis and stable glucose concentrations within an acceptable range.
10.1007/s00508-018-1423-z
[A case of Hamman's syndrome associated with acute-onset type 1 diabetes mellitus presenting with abdominal pain].
Hamamoto Hiromi,Sakaguchi Kosaku,Muro Shinichiro,Sasaki Kyo,Kobayashi Sayo,Fujisawa Tomoo,Nawa Toru,Ueki Toru,Yabushita Kazuhisa,Shimoe Toshinari
Nihon Shokakibyo Gakkai zasshi The Japanese journal of gastro-enterology
A 21-year-old female presented at an emergency department with abdominal pain and nausea. Computed tomography (CT) of the chest and abdomen revealed a small amount of mediastinal emphysema in the precardiac area, but the underlying cause could not be identified. On admission, her plasma glucose was 371 mg/dl, glycated hemoglobin (HbA1c) was 14.0%, and blood pH was 6.91. These findings supported a diagnosis of Hamman's syndrome associated with diabetic ketoacidosis. Her diabetic ketoacidosis was managed with insulin and fluid therapy, and the mediastinal emphysema disappeared spontaneously by the time of discharge. Presence of free air of the chest and abdominal cavity must warrant a differential diagnosis of gastrointestinal perforation; however, when the free air is accompanied by diabetic ketoacidosis, it is not necessary to perform urgent endoscopy.
10.11405/nisshoshi.112.856
Pneumomediastinum, Tracheal Diverticulum, and Probable Asthma: Coincidence or Possible Association? A Case Report.
Cherrez-Ojeda Ivan,Felix Miguel,Vanegas Emanuel,Mata Valeria L
The American journal of case reports
BACKGROUND Many conditions and triggers have been identified and associated with spontaneous pneumomediastinum (SPM), including asthma, strenuous exercise, chronic obstructive pulmonary disease, diabetic ketoacidosis, inhalational drugs, and other activities associated with the Valsalva maneuver. Among rare findings reported in patients with SPM is tracheal diverticulum. We present a case of SPM that on further evaluation was noted to have a tracheal diverticulum, together with a possible diagnosis of asthma. CASE REPORT A 25-year-old male was admitted to the hospital for dyspnea and chest pain. Based on initial assessment, laboratory findings, and imaging, he was diagnosed with SPM. Recovery was successful, and the patient was discharged 3 days later. Follow-up at 2 weeks revealed an abnormality on imaging and abnormal pulmonary function tests. A computed tomography scan revealed a tracheal diverticulum located on the right posterolateral region of the trachea at T1 level. Pulmonary function tests abnormalities included: high fractional exhaled nitric oxide (FeNO), high lung clearance index (LCI), and elevated diffusing capacity of the lungs for carbon monoxide (DLCO). CONCLUSIONS Although the patient presented with a normal spirometry, the FeNO, LCI, and DLCO findings proved valuable and suggested a possible diagnosis of asthma. The anatomic weakness associated with the tracheal diverticulum could have been the breaking point of sustained increased pressure in the airways, due to a possible asthma exacerbation. In retrospective, we hypothesized this to be a series of events that ultimately ended as a pneumomediastinum.
10.12659/AJCR.911413
Mediastinal emphysema after long-distance flight with ketoacidosis and underlying diabetes mellitus type 1.
Respirology case reports
A 21-year old female with diabetes mellitus type 1 presented to our hospital's emergency department having suffered from shortness of breath, mild chest pain, and vomiting following her arrival after a long-distance flight two days earlier. Symptoms had since subsided and physical examination was normal. Blood analysis revealed increased D-dimers and diabetic ketoacidosis. Computed tomography (CT) examination excluded pulmonary embolism but demonstrated significant mediastinal emphysema. After conservative treatment including nasal oxygen and adjustment of insulin therapy, follow-up low-dose CT after four days confirmed full regression of the emphysema. The patient was discharged feeling well, with a recommendation for improved diabetes treatment. Spontaneous pneumomediastinum is a rare condition occurring in younger patients without trauma or pulmonary disease. Over-inflation and/or pulmonary vasoconstriction have been proposed as major physiological contributors and were likely evoked in the present case by increased respiratory drive due to ketoacidosis and hypoxic vasoconstriction during long distance flight.
10.1002/rcr2.423
Mediastinal emphysema complicating diabetic ketoacidosis: plea for conservative diagnostic approach.
Pauw R G,van der Werf T S,van Dullemen H M,Dullaart R P F
The Netherlands journal of medicine
BACKGROUND:Spontaneous pneumomediastinum has been infrequently reported as a complication of diabetic ketoacidosis. Evidence-based guidelines are currently not available to help in choosing the best diagnostic approach. METHODS:We conducted a systematic review of the literature and looked for diagnostic clues that might indicate the need for a work-up to rule out oesophageal perforation. RESULTS:In all 56 published cases of spontaneous pneumomediastinum associated with diabetic ketoacidosis, the condition was self-limiting. We report one additional case of a 31-year-old female who presented with a spontaneous pneumomediastinum and also epidural pneumatosis, complicating diabetic ketoacidosis. CONCLUSION:Important pathology, such as oesophageal rupture, was not detected in any of the reported cases, and we suggest a restrictive diagnostic work-up.
Epidural pneumatosis associated with spontaneous pneumomediastinum: a rare complication of diabetic ketoacidosis.
Ahmed Mohamed,Healy Mary-Louise,O'Shea Donal,Crowley Rachel K
BMJ case reports
Pneumomediastinum and epidural pneumatosis are rare complications of diabetic ketoacidosis (DKA). These result from the emesis and hyperventilation associated with DKA which lead to alveolar rupture and air escape into the mediastinal and epidural spaces. These complications are often asymptomatic and resolve with the correction of the underlying metabolic abnormality. Oesophageal contrast studies are only required if oesophageal perforation is suspected in patients presenting with persistent vomiting and chest pain. We report the rare association of pneumomediastinum and epidural pneumatosis complicating DKA in a 19-year-old female patient.
10.1136/bcr-2016-216295