Prognostic Factors for the Hyperosmolar Nonketotic State

Transcription

1 / 127 = Abstract = Prognostic Factors for the Hyperosmolar Nonketotic State Sung Hun An, M.D., Yang Won Kim, M.D., Mi Ran Kim, M.D., Heon Chul Jin, M.D., Ji Young An, M.D., Sang Lae Lee, M.D., Seok Yong Ryu, M.D., Hong Yong Kim, M.D., Sung Jun Kim, M.D., Gwon Byung Lee, M.D., and Kyung Hwan Kim, M.D. Department of Emergency Medicine, Preventive Medicine, and Internal Medicine, Sanggye Paik Hospital and Ilsan Paik Hospital,*** College of Medicine, Inje University B a c k g r o u n d: A hyperosmolar nonketotic state has been known to have a high mortality, and even now, despite this high mortality, only a few studies of this disease have been performed. We studied the prognostic factors for the hyperosmolar nonketotic state. Methods: We retrospectively studied the cases of 40 patients who were in a hypersomolar nonketotic state when admitted to Sanggye Paik Hospital during the 6-year period from 1995 through We divided the hyperosmolar nonketotic patients into two groups, the complete recovery group and the incomplete recovery group, and compared the clinical features, the laboratory findings, and the precipitating factors between two groups. Results: 1) A total of 40 patients were studied: 24 in the complete recovery group and 16 patients in the incomplete recovery group. The mortality rate was 32.5%. 2) No significant statistical difference existed among the clinical features of the two groups, except for the sex(p<0.01). 3) Among the laboratory findings of both groups, analysis revealed that the effective osmolarity was significantly higher among those in the incomplete recovery group(p<0.01). Serum sodium concentration was also significantly higher among those in the incomplete recovery group(p<0.01). Serum creatinine was also significantly higher among those in the incomplete recovery group(p<0.05). Serum bicarbonate concentration, on the other hand, was significantly lower among those in that group(p<0.05). 4) Infection was identified as the most common precipitating factor(62.5%). Among the precipitating factors of the two groups, there were significant statistical difference in pneumonia, UTI, and inappropriate glucose control. 5) A significant statistical difference existed among the initial level of consciousness of both groups(p<0.05). 6) The only significant independent factor responsible for prognosis of nonketotic hyperosmolar state patients was the sex. Tel : 02) , Fax : 02) , emash@hanmail.net

2 128 / Conclusion: The sex was only significant independent prognostic factor of nonketotic hyperosmolar state patients. Key Word: Hyperosmolar nonketotic state

3 / 129

4 130 /

5 / 131

6 132 /

7 / ,,.. 19: , ,,.. 21: , : , Centers for Disease Control and Prevention. 01. Braaten JT. Hyperosmolar nonketotic diabetic coma: Diagnosis and Management. G e r i a t r i c s 42:83-92, Sament S, Schwartz MB. Severediabetic stupor without ketosis. S Afr Med J 31: , ,,. National Diabetes Fact Sheet: National Estimates and General Information on Diabetes in the United States. Atlanta, US Department of Health and Humand Services, Centers for Disiase Control and Prevention, Steven N, Levine, Trudy H, sanson. Treatment of hyperglycemic hyperosmolar nonketotic syndrome. D r u g s 38: , Chaupin M, Charbonnel B, Chaupin F. C-peptide blood levels in ketoacidosis and in hyperosmolar non-ketotic diabetic coma. Acta Diabet Lat 18:123, Turpin BP, Duckworth WC, Solomon SS. Simulated hyperglycemic hyperosmolar syndrome: Impaired insulin and epinephrine effects upon liposysis in the isolated rat fat cell. J Clin Invest 63:403, Watchtel TJ, Silliman RA, Preston L. Predisposing factors for the diabetic hyperosmolar state. A r c h Intern Med 147: , American Diabetes Association. Clinical Practice Recommendations 1998: Position Statement- Hospital Admission Guidelines for Diabetes Mellitus. Diabetes Care 21(suppl), Gerich JE, Martin MM, Recant L. Clinical and metabolic characteristics of hyperosmolar nonketotic coma. Diabetes 20: , Daniel L. Nonketotic hypertonicity in deabetes mellitus. Med Clinic North Am 79:39-52, Singh I, Marshall MC. Diabetes mellitus in the

8 134 / elderly. Endocrin Metab Clin 24: , Khardori R, Soler NG. Hyperosmolar hyperglycemic nonketotic syndrome; Report of 22 cases and brief review. Am J Med77: , Lorber DL. Nonketotic hypertonicity in diabetes. Endocrinologist 3:29, Arnett AI. Cerebral edema complicating nonketotic hyperosmolar coma. Miner Electrol Metab 12:383, Small M, Alzaid A, MacCuish AC. Diabetic hyperosmolar nonketotic decompensation. Q J Med 66: , 1988.