Severe Hypoglycemia in Adults

Reviews in Endocrine and Metabolic Disorders -     

Ingestion of small flat disc batteries

Management of ingestions of small flat disc batteries has been controversial. The Nassau County Medical Center's Long Island Regional Poison Control Center has had 30 calls concerning battery ingestions in the past 16 months. In 1976, the National Clearinghouse for Poison Control Centers reported 42 battery ingestions for the entire nation. Only one of our cases required surgery because the battery remained in the cecum for five days. The battery was removed intact. Management guidelines for ingestions of batteries containing alkali or toxic metals are suggested.     

Management of a child with acute thyroxine ingestion

We report a case of thyroxine overdose in a child. Despite extremely high thyroxine (T4RIA) levels on admission, the patient's only symptoms were mild hypertension and tachycardia. Both symptoms responded to propranolol, with a drop in pulse rate and a decrease in blood pressure to normal levels. After four days of cardiac monitoring, the patient was released and received propranolol for five additional days as an outpatient.     

Effects of eating on plasma hyaluronan in patients with cirrhosis: Its mechanism and influence on clinical interpretation

Circulating levels of hyaluronan (HA) may be a clinically useful non-invasive test in liver disease to evaluate, for example, the degree of fibrosis or cirrhosis. Healthy subjects exhibit a two-fold or greater postprandial elevation of plasma HA. We undertook this work to determine the effect of eating on plasma HA in patients with cirrhosis, to define mechanisms underlying the changes observed and to examine whether using fasting samples improves the discriminating value of plasma HA as a clinical test. Plasma HA was measured using a protein-binding assay in serial samples obtained over 2.5 h, during which a 2100 kJ meal and/or intravenous infusion of octreotide (25 μg stat, 25 μg stat, 25 μg/h) were given, or in paired random and fasting samples from patients with cirrhosis. In six patients with Pugh's A cirrhosis, plasma HA increased more than two-fold after food ingestion, peaking after 75–90 min. In four patients (one Pugh's A), no response was observed. Octreotide transiently increased plasma HA by a mean of 20%, but, in combination with eating, reduced the peak plasma HA by 80% in responding patients. In 30 patients with cirrhosis, random plasma HA was abnormal in only 70% compared with 93% of autologous fasting samples, using the respective normal ranges ( P =0.01). Ingestion of food markedly increased plasma HA in patients with compensated but not decompensated cirrhosis, most likely due to a postprandial increase in splanchnic blood flow. Fasting patients prior to taking blood improves the clinical discriminating value of plasma HA.     

Diquat intoxication

Reported is the case of a 23-year-old man who ingested 300 mL of Reglone. He developed vomiting five to 10 minutes after ingestion. Shortly thereafter, he developed renal and central nervous system manifestations of toxicity, followed by cardiovascular collapse and death 14 hours after admission. Autopsy findings revealed esophagitis, tracheitis, gastritis, and ileitis. Prompt, aggressive therapy that included fluid replacement and removal of the toxin was unsuccessful.     

长期饮酒胃黏膜病理改变与PGE2和EGF的关系

目的探讨长期饮酒患者胃黏膜病理改变与PGE2和EGF的关系。方法选择因长期饮酒于2007年1月～2010年12月在我院进行胃镜检查并进行胃黏膜活检及血液和胃液前列腺素E2（PGE2）和表皮生长因子（EGF）检测的120例患者作为研究对象。按组织病理学分组进行对照研究。结果与长期饮酒轻度胃黏膜慢性炎症组患者比较,长期饮酒胃黏膜中重度慢性炎症组患者血清和胃液EGF明显升高（P=0.000;P=0.028）,而血清和胃液PGE2升高不明显（P=0.089;P=0.760）。与长期饮酒胃黏膜轻度萎缩组患者比较,长期饮酒胃黏膜中重度萎缩组患者血清EGF明显升高（P=0.000）,而胃液EGF和血清PGE2降低（P=0.846;P=0.362）,胃液PGE2略升高（P=0.936）。与长期饮酒胃黏膜轻度肠化组患者比较,长期饮酒胃黏膜中重度肠化组患者血清EGF明显升高（P=0.000）,而胃液EGF、血清和胃液PGE2升高,但差异无统计学意义（P=0.123;P=0.621;P=0.154）。与长期饮酒胃黏膜无不典型增生组患者比较,长期饮酒胃黏膜不典型增生组患者血清和胃液EGF明显升高（P=0.000;P=0.003）,而血清和胃液PGE2虽升高,但差异无统计学意义（P=0.329;P=0.618）。结论长期饮酒引起EGF分泌升高与胃黏膜慢性炎症、胃黏膜癌前状态和癌前病变的发生和发展有一定的关系,但PGE2在上述病变中变化并不一致,有待于进一步研究。     

Hyperosmolar non-ketotic diabetic coma

Riassunto Vengono riportati 27 casi di sindrome iperosmolare diabetica in 24 pazienti. Nessun caso è insorto in corso di diabete acuto mentre molti casi erano complicati da altre malattie. 10 pazienti crano maschi africani. Si riscontrarono fenomeni convulsivi in 8 casi. Si ebbero 8 dcccssi dovuti all'iperosmolarità, 6 dovuti apparentemente ad altre cause e 13 casi furono ricuperati. Normalmente, nei nostri casi, la glicemia non era più elevata di quanto è dato vedere nella comune chetoacidosi e nello stato iniziale si aggirava fra 466 e 3.120 mg %. Vengono discusse la terapia e la patogenesi della sindrome.

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Summary 27 cases of the diabetic hyperosmolar syndrome are reported in 24 patients. None occurred in severe diabetics and several were complicated by other illnesses. 10 of the patients were African males. Convulsive phenomena occurred in 8 cases; there were 8 deaths from the hyperosmolar state, 6 apparently from other causes, 13 recoveries. The hyperglycaemia is not necessarily more extreme than in ordinary ketoacidosis and initially ranged between 466 and 3,120 mg % in our cases. The therapy and pathogenesis of the syndrome are discussed.

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Zusammenfassung Es werden 27 Faelle von hyperosmolarem Diabetes-Syndrom bei 24 Patienten mitgeteilt. Kein Fall trat im Laufe von akutem Diabetes auf, waehrend viele Faelle durch andere Krankheiten kompliziert waren. 10 Patienten waren afrikanische Maenner. Bei 8 Faellen wurden Krampf-Phaenomene festgestellt. 8 Todesfaelle waren der Hyperosmolaritaet zuzuschreiben, 6 scheinbar anderen Ursachen und 13 Faelle konnten gerettet werden. Gewoehnlich war der Blutzucker bei unseren Faellen nicht hoeher als bei der gewoehnlichen Ketoazidose und bewegte sich zwischen 466 und 3.120 mg %. Es werden die Therapie und Pathogenese des Syndroms diskutiert.

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Resumen Se refieren 27 casos de síndrome hiperosmolar diabética en 24 pacientes. Ningún caso se presentó durante diábetes aguda, mientras muchos casos estaban complicados con otras enfermedades. Diez pacientes eran varones africanos. Se presentaron fenómenos convulsivos en 8 casos. Se verificaron 8 muertes, debidas a hiperosmolaridad, 6 debidas aparentemente a otras causas y 13 casos se recuperaron. Normalmente, en los casos observados por nosotros, la glucemia no era más elevada de lo que se observa en las quetoacidosis comunes y en los estadios iniciales giraba entre 466 y 3.120 mg %. Se discuten la terapéutica y la patogenia del síndrome.

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Resume On rapporte 27 cas de syndrome hyperosmolaire diabétique chez 24 patients. Aucun cas n'est apparu au cours de diabète aigu tandis que de nombreux cas étaient compliqués par d'autres maladies. Dix patients étaient des africains de sexe masculin. Dans 8 cas on a enregistré des phénomènes convulsifs. On a eu 8 décès dus à l'hyperosmolarité, 6 dus apparemment à d'autres causes et 13 cas ont été récupérés. Normalement, dans nos cas, la glycémie n'était pas plus élevée que ce qu'il nous arrive de voir dans la cétoacidose ordinaire et son taux à l'état initial était compris entre 466 et 3.120 mg % environ. On discute du traitement et de la pathogénèse de ce syndrome.