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Limb Ischemia in a Patient with Hyperosmolar Hyperglycemic State
Ahmed Al Hazmi1, Sara Manning2
1University of Maryland Medical Center, Department of Emergency Medicine, Baltimore, Maryland.
Clinical Practice and Cases in Emergency Medicine
|November 17, 2018
Summary
A 61-year-old male developed altered mental status due to hyperosmolar hyperglycemic state (HHS), a complication of prednisone treatment for pemphigus vulgaris. This endocrine emergency can cause arterial thrombosis, requiring prompt medical intervention.
Area of Science:
- Endocrinology
- Internal Medicine
- Neurology
Background:
- Pemphigus vulgaris is an autoimmune blistering disease.
- Corticosteroids like prednisone are common treatments for autoimmune conditions.
- Hyperosmolar hyperglycemic state (HHS) is a serious diabetic complication.
Observation:
- A 61-year-old male with newly diagnosed pemphigus vulgaris presented with altered mental status after starting prednisone.
- The patient experienced a decline in mental status and reduced oral intake.
- Initial evaluation revealed hyperosmolar hyperglycemic state (HHS).
Findings:
- The patient was diagnosed with hyperosmolar hyperglycemic state (HHS).
- Occlusive arterial thrombosis was identified as a complication of HHS.
- This combination of HHS and arterial thrombosis is a rare but documented occurrence.
Implications:
- Emergency physicians must be aware of ischemic complications in patients with HHS.
- Prompt recognition and management of HHS and its complications are crucial.
- Early treatment can significantly decrease morbidity and mortality in this endocrine emergency.
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