Related Experiment Video
Updated: Oct 3, 2025
06:21
Osmotic Minipump Implantation for Increasing Glucose Concentration in Mouse Cerebrospinal Fluid
Published on: April 7, 2023
1.7K
Hyperosmolar Therapy for Diabetic Hyperosmolar Ketoacidosis
Micah LA Heldeweg1, Joris R Drossaers1, Kenrick Berend1
1Department of Internal Medicine, Curaçao Medical Center, Willemstad, Curaçao.
European Journal of Case Reports in Internal Medicine
|February 16, 2022
Summary
Diabetic emergencies with both hyperglycaemic hyperosmolar state (HHS) and diabetic ketoacidosis (DKA) increase mortality risk. Tailored treatment is crucial to prevent rapid serum osmolarity shifts, with hyperosmolar therapy as a consideration.
Area of Science:
- Endocrinology
- Internal Medicine
- Emergency Medicine
Background:
- Hyperglycaemic hyperosmolar state (HHS) and diabetic ketoacidosis (DKA) are severe diabetic emergencies.
- Concurrent HHS and DKA occur in 27% of cases, significantly increasing mortality risk (nearly three-fold).
- Current treatment guidelines may pose risks for patients with combined HHS and DKA.
Purpose of the Study:
- To highlight the treatment challenges in concurrent HHS and DKA.
- To discuss the risks of rapid serum osmolarity shifts during treatment.
- To propose a safer treatment approach for this complex diabetic emergency.
Main Methods:
- Case presentation of a 36-year-old male with concurrent HHS and DKA.
- Review of standard treatment protocols for HHS and DKA.
- Implementation and monitoring of adjusted treatment including hyperosmolar therapy (NaCl 3%).
Main Results:
- Standard treatment led to an excessively rapid decline in serum osmolarity.
- Hyperosmolar therapy was initiated to prevent cerebral osmotic shifts.
- The case illustrates the dilemma of managing osmolarity in combined HHS and DKA.
Conclusions:
- Combined HHS and DKA presents a significant treatment challenge due to the risk of rapid osmolarity shifts.
- Avoiding osmolarity reduction rates above 24 mOsm/l/day is advisable.
- Hyperosmolar therapy, with careful monitoring, is a potential strategy to mitigate risks.
Related Concept Videos
01:15Hypoglycemia and Glucagon
365
Without prolonged fasting, healthy individuals maintain blood glucose levels above 3.5 mM due to a well-adapted neuroendocrine counterregulatory system that effectively prevents acute hypoglycemia, a potentially life-threatening condition. The primary clinical scenarios for hypoglycemia encompass diabetes treatment, inappropriate production of endogenous insulin or insulin-like substances by tumors, and the use of glucose-lowering agents in non-diabetic individuals. Notably, hypoglycemia in the...
365
01:20Acute Kidney Injury V: Interprofessional Care
65
Acute Kidney Injury (AKI) requires a collaborative healthcare approach to restore renal function and prevent complications. Essential management strategies involve monitoring fluid and electrolyte balance, adjusting medications, initiating dialysis when necessary, and providing nutritional support.Fluid and Electrolyte ManagementFluid Monitoring: Regularly monitoring body weight, central venous pressure, and urine output helps detect fluid imbalances early. Patient intake and output are...
65
01:15Diabetes: Management and Pharmacotherapy
428
The therapy for diabetes aims to alleviate hyperglycemia-related symptoms, prevent acute metabolic decompensation, and reduce chronic end-organ complications. Glycemic control is evaluated through short-term (self-monitoring, continuous glucose monitoring) and long-term (A1c, fructosamine) metrics, enabling near real-time tracking of blood glucose levels and reflecting glycemic control over specific time frames.
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
428
01:16Insulin: Dosing Regimen and Adverse Effects
293
Insulin-replacement therapy usually includes both long-acting insulin (basal) and short-acting insulin (to cater to postprandial needs). In a diverse group of type 1 diabetes patients, the average daily insulin dose is typically 0.5-0.7 units/kg body weight. However, obese patients and pubertal adolescents may need more due to insulin resistance.
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
293
01:07Alkylation of β-Ketoester Enolates: Acetoacetic Ester Synthesis
3.7K
Acetoacetic ester synthesis is a method to obtain ketones from alkyl halides and β-keto esters. The reaction occurs in the presence of an alkoxide base that abstracts the acidic proton of the β-keto esters. The step results in an enolate ion which is doubly stabilized. The enolate then reacts with an alkyl halide via the SN2 process to produce an alkylated ester intermediate with a new C–C bond. The hydrolysis of the intermediate, followed by acidification, results in an...
3.7K
01:24Diagnosing Acidosis and Alkalosis
583
Diagnosing acid-base imbalances involves systematically analyzing arterial blood samples, focusing on three key measurements: pH, bicarbonate (HCO3−) concentration, and carbon dioxide partial pressure (PCO2). This analysis follows a four-step process that helps identify the imbalance's underlying cause and nature.
First, the pH level is assessed to determine whether the blood pH is normal (7.35–7.45), low (acidosis), or high (alkalosis).
Next, the PCO2 and...
First, the pH level is assessed to determine whether the blood pH is normal (7.35–7.45), low (acidosis), or high (alkalosis).
Next, the PCO2 and...
583