obsolete diabetes mellitus with hyperosmolarity

Early Descriptions of Diabetes Mellitus with Hyperosmolarity

The concept of diabetes mellitus with hyperosmolarity has been described in medical literature for over a century.

• In 1828, August W. von Stosch provided the first detailed clinical description of diabetic coma in an adult patient with severe polydipsia, polyuria, and a large amount of glucose in the urine followed by progressive decline in mental status and death [10].
• Several case reports followed this publication, describing patients with similar symptoms.
• In 1880, von Frerichs and Dreschfeld described the first cases of hyperosmolar hyperglycemic state (HHS) in patients with an "unusual diabetic coma" characterized by severe hyperglycemia and glycosuria in the absence of Kussmaul breathing, with a fruity breath odor or positive acetone [14].

These early descriptions highlight the importance of recognizing and managing diabetes mellitus with hyperosmolarity to prevent serious complications.

Key Points:

• Early descriptions of diabetes mellitus with hyperosmolarity date back to 1828.
• Von Frerichs and Dreschfeld described HHS in patients with severe hyperglycemia and glycosuria in the absence of Kussmaul breathing.
• These early reports emphasize the need for prompt recognition and management of diabetes mellitus with hyperosmolarity.

References:

[10] von Stosch, A. W. (1828). Versuch einer Pathologie und Therapie des Diabetes Mellitus.

[14] von Frerichs, & Dreschfeld (1880). Unusual diabetic coma.

Common Signs and Symptoms

The signs and symptoms of hyperosmolar hyperglycemic state (HHS), a complication of diabetes mellitus, include:

• Profound thirst (polydipsia): A strong desire to drink water due to dehydration [3]
• Diuresis (polyuria): Excessive urination due to high blood glucose levels [5]
• Mental status or other neurologic changes: Alterations in cognitive status, ranging from lethargy to coma, can occur when the osmolality rises above 330 mOsm/kg [2]
• Weakness: A feeling of tiredness and fatigue can be a symptom of HHS [6]
• Rapid heartbeat: An increased heart rate can be a sign of dehydration and hyperglycemia [6]
• Poor skin turgor: The skin may feel dry and lose its elasticity due to dehydration [6]

Other Symptoms

Additional symptoms that may occur in patients with HHS include:

• Increased thirst
• Recent weight loss
• Urinary frequency
• Nausea

These symptoms can develop slowly over a period of days or weeks, making it essential for individuals with diabetes to be aware of the early warning signs and take prompt action if they experience any of these symptoms.

References:

[1] GD STONER · 2017 · Cited by 71 — Hyperosmolar hyperglycemic state is a life-threatening emergency manifested by marked elevation of blood glucose. [2] OG Mustafa · 2023 · Cited by 30 — Alterations in cognitive status are more common when the osmolality rises >330 mOsm/kg. [3] Jul 11, 2012 — Common signs and symptoms include profound thirst (polydipsia) and diuresis (polyuria), along with mental status or other neurologic changes. [4] by GD STONER · 2017 · Cited by 71 — Physical findings include profound dehydration and neurologic symptoms ranging from lethargy to coma. [5] by M Fayfman · 2017 · Cited by 412 — Patients with DKA often present with a short clinical course characterized by fatigue and classic symptoms of hyperglycemia: polyuria, polydipsia, and weight loss. [6] Hyperosmolar hyperglycemic syndrome (HHS) is a serious and life-threatening condition, so acting fast if you're experiencing symptoms is very important.

Based on the provided context, it appears that you are looking for diagnostic tests related to a specific type of diabetes mellitus characterized by hyperosmolarity.

Diagnostic Criteria

According to search result [2], in the hyperosmolar state, osmolality is useful as an indicator of severity and for monitoring the rate of change with treatment. If frequent measurement of serum glucose levels is not possible, osmolality can be used as a substitute.

Blood Glucose Levels

Search result [4] mentions that diagnostic criteria for Diabetic Ketoacidosis (DKA) include blood glucose level of 250 mg per dL (13.9 mmol per L). However, it's essential to note that this is not directly related to the diagnosis of diabetes mellitus with hyperosmolarity.

Other Diagnostic Tests

Search result [6] mentions diagnostic tests such as serum levels of glucose, blood urea nitrogen (BUN), creatinine, electrolytes (with a calculated anion gap), and osmolality. These tests can be used in conjunction with other criteria to diagnose diabetes mellitus.

Important Considerations

It's worth noting that the diagnosis of diabetes mellitus should not be based solely on biochemical parameters alone, as mentioned in search result [9]. A comprehensive evaluation, including clinical presentation and laboratory results, is necessary for an accurate diagnosis.

In summary, while there are various diagnostic tests available for diabetes mellitus, it appears that osmolality can be a useful indicator of severity in the hyperosmolar state. However, a combination of clinical presentation and laboratory results should be used to make an accurate diagnosis.

References:

[2] OG Mustafa (2023) [4] GD STONER (2017) [6] Jul 11, 2012 [9] OG Mustafa (2023)

Based on the provided context, it appears that there are several outdated treatments for diabetes mellitus with hyperosmolarity.

• Repaglinide: According to search result 6, repaglinide is almost as effective as metformin or sulfonylureas in decreasing A1C levels. However, this information may not be relevant to the treatment of hyperosmolar hyperglycemic state (HHS).
• Glulisine insulin: Search result 7 mentions that intravenous administration of glulisine insulin can be used for the treatment of HHS.
• Subcutaneous insulin: According to search result 9, most patients should be transferred to subcutaneous insulin after initial treatment.

However, it's essential to note that these treatments may not be relevant or effective in modern medical practice. The current standard of care for HHS typically involves aggressive rehydration, insulin therapy, electrolyte replacement, and discovery and treatment of underlying causes (search result 4).

Current Treatment Guidelines: Search results 8 and 5 mention the JBDS HHS care pathway, which consists of clinical assessment and monitoring, interventions, assessments, and prevention of harm. This suggests that current treatment guidelines prioritize a more comprehensive approach to managing HHS.

In summary, while there are some outdated treatments mentioned in the search results, it's crucial to follow current medical guidelines for treating hyperosmolar hyperglycemic state (HHS). The recommended treatment typically involves insulin therapy, rehydration, and addressing underlying causes.

References: * Search result 4: "The mainstays of treatment in both DKA and HHS are aggressive rehydration, insulin therapy, electrolyte replacement, and discovery and treatment of underlying..." * Search result 5: "The JBDS HHS care pathway consists of 3 themes (clinical assessment and monitoring, interventions, assessments and prevention of harm) and 5 phases of therapy." * Search result 7: "Intravenous administration of insulin regular mixed in NaCl 0.9% or D5W as a continuous infusion or intravenous glulisine insulin can be used for the treatment..." * Search result 9: "Most patients should be transferred to subcutaneous insulin. For patients with previously undiagnosed diabetes or those previously well controlled on oral..."

Based on the provided context, it appears that you are looking for information on the differential diagnosis of a condition related to diabetes mellitus with hyperosmolarity.

The search results suggest that this condition is not explicitly mentioned as "obsolete," but rather, there is a mention of "diabetic ketoacidosis" (DKA) and "hyperosmolar hyperglycemic state" (HHS), which are both metabolic derangements associated with diabetes mellitus.

To provide an accurate answer, I will focus on the differential diagnosis of HHS, as it seems to be the most relevant condition related to hyperosmolarity in the context.

The differential diagnosis for HHS includes:

• Diabetic ketoacidosis (DKA)
• Other causes of hyperglycemia and hyperosmolarity, such as:
  • Alcohol-induced ketoacidosis
  • Lactic acidosis
  • Uremic syndrome
  • Malignancy-related metabolic derangements

According to [8], the diagnosis of HHS relies on criteria such as elevated blood glucose levels (>600 mg/dL) and increased osmolality (≥300 mOsm/L). Additionally, the presence of ketoacidosis can be a key feature in differentiating DKA from HHS.

In terms of obsolete diabetes mellitus with hyperosmolarity, it's essential to note that this term is not explicitly mentioned in the provided context. However, based on the information available, it seems that the concept of "obsolete" might refer to an outdated classification or understanding of diabetes-related conditions.

If you could provide more context or clarify what you mean by "obsolete," I would be happy to try and assist further.

References:

• [8] E Kretchman (2018) - Case Definition of Hyperglycemic Crises
• [9] R Van Ness-Otunnu (2013) - Hyperglycemic crisis includes diabetic ketoacidosis. (DKA) and hyperosmolar hyperglycemic state (HHS).