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[The hyperglycemic dehydration syndrome]

P H Melief1, P H de Meijer, A E Meinders

  • 1Leids Universitair Medisch Centrum, afd. Algemene Interne Geneeskunde, RC, Leiden.

Nederlands Tijdschrift Voor Geneeskunde
|October 9, 1998
PubMed
Summary
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Hyperglycemic hyperosmolar non-ketoacidotic disorder, a severe diabetes complication, can manifest initially in adults. Prompt treatment with saline and glucose solutions leads to full recovery.

Area of Science:

  • Endocrinology
  • Metabolic Disorders
  • Neurology

Background:

  • Type 2 diabetes mellitus (T2DM) is a progressive metabolic disorder characterized by insulin resistance and impaired insulin secretion.
  • Hyperglycemic hyperosmolar non-ketoacidotic disorder (HHNMD) is a serious acute complication of T2DM, often presenting as the first clinical manifestation.
  • HHNMD is characterized by severe hyperglycemia, profound dehydration, and hyperosmolarity without significant ketoacidosis.

Observation:

  • Two adult male patients, aged 47 and 64, presented with coma following symptoms of fatigue, polyuria (excessive urination), and polydipsia (excessive thirst).
  • Neither patient had a prior diagnosis of diabetes mellitus.
  • Initial investigations revealed hyperglycemic hyperosmolar non-ketoacidotic disorder as the first presentation of T2DM.

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Findings:

  • In HHNMD, residual insulin is insufficient to prevent ketone body formation but adequate to inhibit excessive ketogenesis, leading to hyperglycemia without ketoacidosis.
  • Severe dehydration, resulting from osmotic diuresis, can precipitate neurological complications and thromboembolic events, creating a detrimental cycle of worsening hyperglycemia and renal impairment.
  • Both patients experienced a full recovery following intravenous administration of sodium chloride and glucose solutions.

Implications:

  • HHNMD can be the initial presentation of T2DM in adults, highlighting the importance of considering diabetes in patients with unexplained coma and dehydration.
  • Early recognition and prompt, aggressive fluid and electrolyte management are crucial for reversing the severe dehydration and metabolic derangements associated with HHNMD.
  • This case underscores the potential for complete recovery from HHNMD with appropriate medical intervention, even in severe presentations.