Hyperosmolar hyperglycemic state history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
The majority of patients with [disease name] are asymptomatic. OR The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].
History
Age of onset
- Older adults especially with low perception of thirst or low fluid intake tend to present more likely with hyperosmolar hyperglycemic state (HHS) as the first presentation of type 2 diabetes.[1][2]
- Hyperosmolar hyperglycemic state has also been seen in young adults and childeren with type 1 diabetes but less commonly.[3]
Family history
- Patients who have a family history of diabetes have less chance of developing diabetic complications, possibly due to increased awareness of diabetes.[4]
Initial presentation
- Patients presents with tiredness, nausea, cramps, and fatigue.
- Patients may present with a history of poor compliance with insulin therapy or missed insulin injections due to vomiting or psychological reasons.
- Hyperosmolar hyperglycemic state has a slower onset, with symtoms developing over several days to weeks as compared to diabetic ketoacidosis which presents within hours.
Past medical history
- Hyperosmolar hyperglycemic state is associated with a past medical history of type 2 diabetes. Type 1 diabetes melitus may also lead to HHS is rare cases.[5][6]
- History of other comorbidies such as cerbrovascular diseases, myocardial infarcstions etc can precipitate hyperosmolar hyperglycemic state by releasing counterregularotry hormones.
- History of infections (for example, urinary tract infections, pneumonia in an individual suffering from type 2 diabetes.[7]
Social history
- Patients may have a history of use of illicit drugs, for example, alcohol and cocaine.[8]
- Patients may have poor socioeconomic status, which contributes to poor medication adherence in diabetics.[9]
- Elederly patients in instutionalized care may have poor fluid intake.
Symptoms
Early Symptoms
The early symtoms of hyperosmolar hyperglycemis state are due to hyperglycemia and dehydration which include:[10][11]
- Polyuria
- Polydypsia
- Weakness
- Leg cramps
- Nausea and vomiting
- Sluggish, extreme tiredness
- Lethargy and apathy
- Symptoms of underlying illness
Late Symptoms
The following are late symptoms of hyperosmolar hyperglycemic state which are due to plasma osmolaltiy:[12][13][14][15][16][17]
References
- ↑ de Vries L, Oren L, Lazar L, Lebenthal Y, Shalitin S, Phillip M (2013). "Factors associated with diabetic ketoacidosis at onset of Type 1 diabetes in children and adolescents". Diabet. Med. 30 (11): 1360–6. doi:10.1111/dme.12252. PMID 23758313.
- ↑ "Ketoacidosis at first presentation of type 1 diabetes mellitus among children: a study from Kuwait | Scientific Reports".
- ↑ Bagdure D, Rewers A, Campagna E, Sills MR (2013). "Epidemiology of hyperglycemic hyperosmolar syndrome in children hospitalized in USA". Pediatr Diabetes. 14 (1): 18–24. doi:10.1111/j.1399-5448.2012.00897.x. PMID 22925225.
- ↑ Hekkala A, Ilonen J, Knip M, Veijola R (2011). "Family history of diabetes and distribution of class II HLA genotypes in children with newly diagnosed type 1 diabetes: effect on diabetic ketoacidosis". Eur. J. Endocrinol. 165 (5): 813–7. doi:10.1530/EJE-11-0376. PMID 21890652.
- ↑ Newton CA, Raskin P (2004). "Diabetic ketoacidosis in type 1 and type 2 diabetes mellitus: clinical and biochemical differences". Arch. Intern. Med. 164 (17): 1925–31. doi:10.1001/archinte.164.17.1925. PMID 15451769.
- ↑ Lin MV, Bishop G, Benito-Herrero M (2010). "Diabetic ketoacidosis in type 2 diabetics: a novel presentation of pancreatic adenocarcinoma". J Gen Intern Med. 25 (4): 369–73. doi:10.1007/s11606-009-1237-9. PMC 2842543. PMID 20119682.
- ↑ Casqueiro J, Casqueiro J, Alves C (2012). "Infections in patients with diabetes mellitus: A review of pathogenesis". Indian J Endocrinol Metab. 16 Suppl 1: S27–36. doi:10.4103/2230-8210.94253. PMC 3354930. PMID 22701840.
- ↑ Warner EA, Greene GS, Buchsbaum MS, Cooper DS, Robinson BE (1998). "Diabetic ketoacidosis associated with cocaine use". Arch. Intern. Med. 158 (16): 1799–802. PMID 9738609.
- ↑ Lewis KR, Clark C, Velarde MC (2014). "Socioeconomic factors associated with pediatric diabetic ketoacidosis admissions in Southern West Virginia". Clin. Endocrinol. (Oxf). 81 (2): 218–21. doi:10.1111/cen.12350. PMID 24117508.
- ↑ Westerberg DP (2013). "Diabetic ketoacidosis: evaluation and treatment". Am Fam Physician. 87 (5): 337–46. PMID 23547550.
- ↑ Roche EF, Menon A, Gill D, Hoey H (2005). "Clinical presentation of type 1 diabetes". Pediatr Diabetes. 6 (2): 75–8. doi:10.1111/j.1399-543X.2005.00110.x. PMID 15963033.
- ↑ Seth P, Kaur H, Kaur M (2015). "Clinical Profile of Diabetic Ketoacidosis: A Prospective Study in a Tertiary Care Hospital". J Clin Diagn Res. 9 (6): OC01–4. doi:10.7860/JCDR/2015/8586.5995. PMC 4525534. PMID 26266145.
- ↑ Barrett EJ, Sherwin RS (1983). "Gastrointestinal manifestations of diabetic ketoacidosis". Yale J Biol Med. 56 (3): 175–8. PMC 2589676. PMID 6419481.
- ↑ 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.
- ↑ Lorber D (1995). "Nonketotic hypertonicity in diabetes mellitus". Med. Clin. North Am. 79 (1): 39–52. PMID 7808094.
- ↑ Maccario M (1968). "Neurological dysfunction associated with nonketotic hyperglycemia". Arch. Neurol. 19 (5): 525–34. PMID 5684300.
- ↑ Guisado R, Arieff AI (1975). "Neurologic manifestations of diabetic comas: correlation with biochemical alterations in the brain". Metab. Clin. Exp. 24 (5): 665–79. PMID 805337.