Hyperosmolar hyperglycemic state physical examination: Difference between revisions

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Revision as of 20:01, 22 September 2017

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].

OR

Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

Physical Examination

Appearance of the Patient

Patient may look fatigue, ill-appearing, diaphoretic, disoriented or obtunded due to severe hyperglycemia and hyperosmolality.^[1]

Vital Signs

Skin

Poor skin turgor due to dehydration
Cutaneous infection (non-healing ulcer)^[5]
Xerosis^[5]
Hair loss^[5]
Acanthosis nigricans in type 2 diabetics^[6]
Diabetic dermopathy (small <1 cm, well-demarcated, atrophic depressions, macules, or papules on the pretibia) in type 2 diabetics^[7]
Eruptive xanthomas in type 2 diabetics^[8]^[5]
Necrobiosis lipoidica (irregular, painless ovoid plaques with a yellow atrophic center and a red to purple periphery)^[5]
Vitiligo^[5]
Diabetic bullae^[9]^[5]

HEENT

Extra-ocular movements may be abnormal due to the involvement of third, fourth, sixth, and seventh cranial nerves affecting ocular movements^[10]
Ophthalmoscopic exam may be abnormal with findings of diabetic retinopathy.
Hearing acuity may be reduced.
Sunken eyes due to dehydratiohn.

Neck

Not significant

Lungs

Rales/crackles due to pulmonary edema (in case of treatmnet complication) or pneumonia (in cases where infection is a precipitating cause)^[11]

Heart

S1 normal
S2 normal
U wave (hypokalemia)^[12]
Cardiac arrhythmia (Atrial fibrillation and ventricular arrhythmia^[13]

Abdomen

Back

Not significant

Genitourinary

Polyuria^[3]

Neuromuscular

Extremities

Muscle cramping^[15]
Cold extremities^[3]

References

↑ "Hyperglycemic Crises: Diabetic Ketoacidosis (DKA), And Hyperglycemic Hyperosmolar State (HHS) - Endotext - NCBI Bookshelf".
↑ Gale EA, Tattersall RB (1978). "Hypothermia: a complication of diabetic ketoacidosis". Br Med J. 2 (6149): 1387–9. PMC 1608617. PMID 102402.
↑ ^3.0 ^3.1 ^3.2 ^3.3 Kearney T, Dang C (2007). "Diabetic and endocrine emergencies". Postgrad Med J. 83 (976): 79–86. doi:10.1136/pgmj.2006.049445. PMC 2805944. PMID 17308209.
↑ Rosenbloom AL (2010). "The management of diabetic ketoacidosis in children". Diabetes Ther. 1 (2): 103–20. doi:10.1007/s13300-010-0008-2. PMC 3138479. PMID 22127748.
↑ ^5.0 ^5.1 ^5.2 ^5.3 ^5.4 ^5.5 ^5.6 Duff M, Demidova O, Blackburn S, Shubrook J (2015). "Cutaneous manifestations of diabetes mellitus". Clin Diabetes. 33 (1): 40–8. doi:10.2337/diaclin.33.1.40. PMC 4299750. PMID 25653473.
↑ "Chapter 151. Diabetes Mellitus and Other Endocrine Diseases | Fitzpatrick's Dermatology in General Medicine, 8e | AccessMedicine | McGraw-Hill Medical".
↑ "Chapter 66. Dermal Hypertrophies and Benign Fibroblastic/Myofibroblastic Tumors | Fitzpatrick's Dermatology in General Medicine, 8e | AccessMedicine | McGraw-Hill Medical".
↑ Paron NG, Lambert PW (2000). "Cutaneous manifestations of diabetes mellitus". Prim. Care. 27 (2): 371–83. PMID 10815049.
↑ Ferringer T, Miller F (2002). "Cutaneous manifestations of diabetes mellitus". Dermatol Clin. 20 (3): 483–92. PMID 12170881.
↑ Skarbez K, Priestley Y, Hoepf M, Koevary SB (2010). "Comprehensive Review of the Effects of Diabetes on Ocular Health". Expert Rev Ophthalmol. 5 (4): 557–577. doi:10.1586/eop.10.44. PMC 3134329. PMID 21760834.
↑ Konstantinov NK, Rohrscheib M, Agaba EI, Dorin RI, Murata GH, Tzamaloukas AH (2015). "Respiratory failure in diabetic ketoacidosis". World J Diabetes. 6 (8): 1009–23. doi:10.4239/wjd.v6.i8.1009. PMC 4515441. PMID 26240698.
↑ Davis SM, Maddux AB, Alonso GT, Okada CR, Mourani PM, Maahs DM (2016). "Profound hypokalemia associated with severe diabetic ketoacidosis". Pediatr Diabetes. 17 (1): 61–5. doi:10.1111/pedi.12246. PMC 4896141. PMID 25430801.
↑ Koektuerk B, Aksoy M, Horlitz M, Bozdag-Turan I, Turan RG (2016). "Role of diabetes in heart rhythm disorders". World J Diabetes. 7 (3): 45–9. doi:10.4239/wjd.v7.i3.45. PMC 4733448. PMID 26862372.
↑ Yun C, Xuefeng W (2013). "Association between seizures and diabetes mellitus: a comprehensive review of literature". Curr Diabetes Rev. 9 (4): 350–4. PMID 23590576.
↑ Wyatt LH, Ferrance RJ (2006). "The musculoskeletal effects of diabetes mellitus". J Can Chiropr Assoc. 50 (1): 43–50. PMC 1839979. PMID 17549168.

Template:WH Template:WS

[urlHyperglycemic_Crises:_Diabetic_Ketoacidosis_(DKA),_And_Hyperglycemic_Hyperosmolar_State_(HHS)_-_Endotext_-_NCBI_Bookshelf-1] "Hyperglycemic Crises: Diabetic Ketoacidosis (DKA), And Hyperglycemic Hyperosmolar State (HHS) - Endotext - NCBI Bookshelf".

[pmid102402-2] Gale EA, Tattersall RB (1978). "Hypothermia: a complication of diabetic ketoacidosis". Br Med J. 2 (6149): 1387–9. PMC 1608617. PMID 102402.

[pmid17308209-3] 3.0 ^3.1 ^3.2 ^3.3 Kearney T, Dang C (2007). "Diabetic and endocrine emergencies". Postgrad Med J. 83 (976): 79–86. doi:10.1136/pgmj.2006.049445. PMC 2805944. PMID 17308209.

[pmid22127748-4] Rosenbloom AL (2010). "The management of diabetic ketoacidosis in children". Diabetes Ther. 1 (2): 103–20. doi:10.1007/s13300-010-0008-2. PMC 3138479. PMID 22127748.

[pmid25653473-5] 5.0 ^5.1 ^5.2 ^5.3 ^5.4 ^5.5 ^5.6 Duff M, Demidova O, Blackburn S, Shubrook J (2015). "Cutaneous manifestations of diabetes mellitus". Clin Diabetes. 33 (1): 40–8. doi:10.2337/diaclin.33.1.40. PMC 4299750. PMID 25653473.

[urlChapter_151._Diabetes_Mellitus_and_Other_Endocrine_Diseases_|_Fitzpatricks_Dermatology_in_General_Medicine,_8e_|_AccessMedicine_|_McGraw-Hill_Medical-6] "Chapter 151. Diabetes Mellitus and Other Endocrine Diseases | Fitzpatrick's Dermatology in General Medicine, 8e | AccessMedicine | McGraw-Hill Medical".

[urlChapter_66._Dermal_Hypertrophies_and_Benign_Fibroblastic/Myofibroblastic_Tumors_|_Fitzpatricks_Dermatology_in_General_Medicine,_8e_|_AccessMedicine_|_McGraw-Hill_Medical-7] "Chapter 66. Dermal Hypertrophies and Benign Fibroblastic/Myofibroblastic Tumors | Fitzpatrick's Dermatology in General Medicine, 8e | AccessMedicine | McGraw-Hill Medical".

[pmid10815049-8] Paron NG, Lambert PW (2000). "Cutaneous manifestations of diabetes mellitus". Prim. Care. 27 (2): 371–83. PMID 10815049.

[pmid12170881-9] Ferringer T, Miller F (2002). "Cutaneous manifestations of diabetes mellitus". Dermatol Clin. 20 (3): 483–92. PMID 12170881.

[pmid21760834-10] Skarbez K, Priestley Y, Hoepf M, Koevary SB (2010). "Comprehensive Review of the Effects of Diabetes on Ocular Health". Expert Rev Ophthalmol. 5 (4): 557–577. doi:10.1586/eop.10.44. PMC 3134329. PMID 21760834.

[pmid26240698-11] Konstantinov NK, Rohrscheib M, Agaba EI, Dorin RI, Murata GH, Tzamaloukas AH (2015). "Respiratory failure in diabetic ketoacidosis". World J Diabetes. 6 (8): 1009–23. doi:10.4239/wjd.v6.i8.1009. PMC 4515441. PMID 26240698.

[pmid25430801-12] Davis SM, Maddux AB, Alonso GT, Okada CR, Mourani PM, Maahs DM (2016). "Profound hypokalemia associated with severe diabetic ketoacidosis". Pediatr Diabetes. 17 (1): 61–5. doi:10.1111/pedi.12246. PMC 4896141. PMID 25430801.

[pmid26862372-13] Koektuerk B, Aksoy M, Horlitz M, Bozdag-Turan I, Turan RG (2016). "Role of diabetes in heart rhythm disorders". World J Diabetes. 7 (3): 45–9. doi:10.4239/wjd.v7.i3.45. PMC 4733448. PMID 26862372.

[pmid23590576-14] Yun C, Xuefeng W (2013). "Association between seizures and diabetes mellitus: a comprehensive review of literature". Curr Diabetes Rev. 9 (4): 350–4. PMID 23590576.

[pmid17549168-15] Wyatt LH, Ferrance RJ (2006). "The musculoskeletal effects of diabetes mellitus". J Can Chiropr Assoc. 50 (1): 43–50. PMC 1839979. PMID 17549168.

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@@ Line 54: / Line 54: @@
 ===Heart===
-*Chest tenderness upon palpation
+* [[Heart sounds|S1]] normal
-*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
+* [[Heart sounds|S2]] normal
-*[[Heave]] / [[thrill]]
+* [[The U Wave|U wave]] ([[hypokalemia]])<ref name="pmid25430801">{{cite journal |vauthors=Davis SM, Maddux AB, Alonso GT, Okada CR, Mourani PM, Maahs DM |title=Profound hypokalemia associated with severe diabetic ketoacidosis |journal=Pediatr Diabetes |volume=17 |issue=1 |pages=61–5 |year=2016 |pmid=25430801 |pmc=4896141 |doi=10.1111/pedi.12246 |url=}}</ref>
-*[[Friction rub]]
+* [[Cardiac arrhythmia]] ([[Atrial fibrillation]] and [[Ventricular arrhythmias|ventricular arrhythmia]]<ref name="pmid26862372">{{cite journal |vauthors=Koektuerk B, Aksoy M, Horlitz M, Bozdag-Turan I, Turan RG |title=Role of diabetes in heart rhythm disorders |journal=World J Diabetes |volume=7 |issue=3 |pages=45–9 |year=2016 |pmid=26862372 |pmc=4733448 |doi=10.4239/wjd.v7.i3.45 |url=}}</ref>
-*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
-*[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]]
-*[[Heart sounds#Third heart sound S3|S3]]
-*[[Heart sounds#Fourth heart sound S4|S4]]
-*[[Heart sounds#Summation Gallop|Gallops]]
-*A high/low grade early/late [[systolic murmur]] / [[diastolic murmur]] best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the otoscope
 ===Abdomen===