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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

An algorithm for differential diagnosis of comatose conditions in patients with diabetes mellitus has been devised. The algorithm is intended for the general practitioner and non-specialized department. The algorithm uses the minimum of the crucial signs of comatose conditions, ensuring their diagnosis under the conditions of any hospital. The algorithm can be applied to the recognition of the typical variants of comatose conditions in a "pure" form. The amount of algorithm steps is minimized. The program of differential diagnosis is written in the Fokal language and realized on the computer "Elektronika BK 0010". The program is run in the dialogue mode. The algorithm is used in clinical practice and in the training process, with its efficacy being independent of the professional skills of the user.
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PMID:[The use of a computer for the diagnosis of comatose states in diabetics (a differential diagnostic algorithm)]. 269 57

Minimizing the need for hospital admissions for hyperglycaemic coma, hypoglycaemic coma and amputation of the lower limbs in patients with diabetes can be regarded as some of the legitimate objectives of a local diabetes service. Routinely collected data are available to calculate rates for such admissions for health service districts and for regions or their equivalents. East Anglian regional rates for admissions mentioning hyperglycaemic coma fell between 1981 and 1986 while rates for those mentioning hypoglycaemic coma rose. Amputation rates remained steady. Between-district variation for all rates was considerable and certain districts showed consistently high rates from year to year for hyperglycaemic coma with others having consistently high rates for amputations. Lack of standardization of case definition and uncertainty about the validity of routinely collected hospital admission data are the most important drawbacks of this approach. With careful interpretation, however, these data provide a possible source for the measurement of the effectiveness of local diabetes services.
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PMID:Outcome indicators for diabetes services--what do we have and what do we need? 272 Nov 48

The health condition of man has changed considerably since life insurance companies have been established. The initial problem of the companies was the fact that many young persons died from tuberculosis. For many decades persons from families with tuberculosis cases or with underweight were not accepted for insurance on their lives. Nevertheless companies observed many deaths causes by this disease. Medical directors and actuaries studied these cases in detail (dates and numbers), even of the deceased. The resulting statistics formed the premium calculation basis for persons with an increased risk. Comparative studies allowed acceptance for more people. Within the last decades when sulfonamides, antibiotics and insulin were discovered and produced the mortality ratio decreased. Nowadays, even persons who suffered from tuberculosis do not present an increased risk anymore. The life expectancy has doubled during the last century. This is why degenerative diseases increased, especially the coronary heart diseases. While thirty years ago the mortality ratio stood at about 500%, improved medical and surgical therapy made prognosis easier and when risk factors can be eliminated the mortality ratio tends to be less than 200%. Since insulin is available, patients with type I-diabetes do not die anymore in coma, the remaining risk is the sclerosis of the vessels. Diabetes with adults increases with overweight, high blood pressure and hyperlipemia. The mortality ratio depends on these risk factors. Morbus Crohn, first described in 1932, seems to increase. Life insurance needs more long-term statistical data. For only some years we are confronted with the immunodeficiency "Aids".(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Change in the panorama of chronic diseases and their insurability by life insurance]. 273 88

A radiological diagnosis of hemorrhagic infarction (HI) was made in 41 of 2726 cases with cerebrovascular lesions (1.9%). The clinical records of the cases and those of 82 age- and gender-matched subjects with ischemic infarction were examined, and notes of the principal risk factors of cerebrovascular disorders, the clinico-radiologic features and the outcome of the disease were taken for comparison. Cardiac sources of emboli (atrial fibrillation, native or prosthetic valve disorders, recent myocardial infarction) were present in 44% of cases and in 24% of controls. Diabetes mellitus was recorded in 31% and 18% respectively. Thirteen percent of cases and 35% of controls gave a history of transient ischemic attacks. Stupor or coma during the acute phase and a more severe course were more common among cases. In general, HIs were significantly larger than ischemic infarcts, with mass-effect, although the size of the lesion did not seem to be related to the presence of cardiogenic embolism.
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PMID:Hemorrhagic infarction: risk factors, clinical and tomographic features, and outcome. A case-control study. 280 Oct 19

A case of central pontine myelinolysis (CPM) followed by hyperglycemia and hypoglycemia was reported. The case was 53-year-old female. Diabetes mellitus was found when she was 32 years old, insulin therapy was started at 37 years of age. Since she was 50 years old, proteinuria and ankle edema had developed and she was admitted to The Keihin Hospital. The peritoneal dialysis (PD) was performed next year, followed by the hemodialysis (HD). In January 1978, strange movements and the disturbance of her consciousness were occurred during PD, then blood glucose level showed over 1,800 mg/dl and serum osmolarity was over 390 mosm/KgH2O. Then she was diagnosed as non-ketotic hyperosmolar coma. After that, during HD and PD, hyperglycemia (approximately 1,200 mg/dl) and hypoglycemia (approximately 40 mg/dl) developed frequently. She died soon after HD on 19th December 1979. The autopsy disclosed bilateral atrophic kidneys due to diabetic changes and atrophic pancreas. Gross neuropathological findings revealed a few small infarcts at the putamen and the globus pallidus, however, other area were observed to be normal. The most remarkable change in microscopical finding was nearly symmetrical demyelinative lesion in the center of the basis pontis. The nerve cells and axon cylinders were relatively well preserved in the demyelinative lesion. The hyaline degeneration was observed in the arterial wall, however, any arterial obstruction was not found. Recent studies would suggest that the electrolyte disturbance, such as hyponatremia, may lead to CPM, particularly when this disturbance was rapidly corrected. On the other hand, CPM induced by diabetic coma has been reported, however, its pathogenesis has been unclear.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Central pontine myelinolysis followed by frequent hyperglycemia and hypoglycemia--report of an autopsy case]. 280 35

Hospital admissions data for 1981 reveal that, for the population of East Anglia, 1.6% of hospital bed days were attributed to diabetes mellitus as the principal cause for admission. Admissions for diabetes without complications or with ketoacidosis or other coma accounted for about 60% of bed days while the other specified complications of diabetes accounted for the remainder. Admissions with diabetes as a subsidiary diagnosis accounted for 2.6 times as many bed days as those for which the disease was the principal diagnosis. Ischaemic heart disease or cerebrovascular disease was recorded as principal diagnosis significantly more often than would be expected from the general population experience, particularly for female diabetics. On an average day, 5.6% of beds were occupied by diabetic patients. The diabetic population of East Anglia used, on average, 5.1 hospital bed days per person year compared with 1.1 days for the non-diabetic population.
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PMID:Hospital admissions of diabetic patients: information from hospital activity analysis. 295 Oct 62

The three Community Hospital-based Stroke Programs collected data on 4132 stroke patients admitted to acute care hospitals during 1979 and 1980. White female stroke patients were older than the white male, nonwhite female and nonwhite male stroke patients. Nearly one-fourth (23%) of stroke patients were employed at the time of the event. Most (77%) of the patients were hospitalized for first stroke episodes. Eighty-three percent of the patients had at least one of the four major risk factors for stroke, namely, hypertension, diabetes, transient ischemic attacks and cardiac disease. Half (49%) of the patients were alert at the time of admission. The three diagnostic categories included infarction (60%), stroke not otherwise specified (30%) and hemorrhage (10%). Fourteen days was the median length of hospitalization; 50% of the stroke patients were discharged to a home setting, 31% were institutionalized and 19% died while in the hospital. The mean Barthel Index score for 2400 patients at the time of discharge was 61.8 (normal is 100). Of those patients who were working at the time of the stroke, 22% returned to work. In comparison to the patients in the National Survey of Stroke, patients in this Study were less severe at the time of admission (49% of patients in the National Survey of Stroke were stuporous or comatose compared to 21% of the patients in the current Study). The inhospital fatality was 30.7% in the National Survey of Stroke, and 19.7% in the current Study.
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PMID:Community Hospital-based Stroke Programs: North Carolina, Oregon, and New York. II: Description of study population. 308 36

Twenty-four patients suffering hyperglycemic hyperosmolar nonketotic syndrome were studied retrospectively to define initial prognostic factors. Twenty percent of these elderly patients (mean age 76 +/- 4.6 yr) had no history of diabetes, and only 54% experienced coma, which was not related to the level of plasma osmolality or to final outcome. The overall mortality was 46%, but death was directly related to nonmetabolic disorders in 64% of cases. Age; sex; acute precipitating factors (except precipitating drugs); admission levels of serum sodium, serum potassium, blood glucose, plasma osmolality, and serum creatinine; and insulin, macromolecular, and total fluid volumes infused during the first 24 h in the ICU were not related to death. The simplified acute physiology score was approximately the same for both survivors and nonsurvivors.
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PMID:Prognostic factors in hyperglycemic hyperosmolar nonketotic syndrome. 308 33

Necrotizing fasciitis is a rapidly spreading infection of the subcutaneous tissue and fascia; diabetes mellitus appears to be the most frequent underlying disease. Early diagnosis and immediate aggressive surgical therapy are paramount to curtail morbidity and mortality, but diagnosis is often difficult and unnecessarily delayed. We describe a case of necrotizing fasciitis precipitating diabetic ketoacidotic coma where correct diagnosis was not made until the 14th hospital day. We stress the fact that physicians caring for critically ill patients should be keenly aware of the possibility of necrotizing fasciitis when tending diabetic patients with unexplained fever; failure to recognize the disease can have devastating results. Finally, we believe this to be the first reported case of diabetic ketoacidotic coma precipitated by necrotizing fasciitis.
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PMID:Necrotizing fasciitis precipitating diabetic ketoacidotic coma. 309 7

A patient who developed hyperosmolar, hyperglycemic, nonketotic coma (HHNC) while receiving home total parenteral nutrient (TPN) therapy is described, and the etiology, clinical features, and treatment of HHNC are reviewed. A 51-year-old black man diagnosed as having Dukes' stage D signet-cell carcinoma of the rectum was discharged on home TPN therapy after a prolonged hospital course and the persistence of a gastrointestinal fistula. Seventeen days after discharge, the patient developed polyuria, became febrile, and lost mental acuity. Upon hospitalization, the patient's physical condition and laboratory values were consistent with the diagnosis of HHNC. The patient was treated with intravenous fluids and small quantities of insulin. The patient's home records indicated that he had lost large volumes of fluid through his fistula, resulting in a net negative fluid balance. The patient's records also indicated that he had had mild glycosuria with a normal urine output at home. This normal urine output despite a body-fluid deficit could be explained by osmotic diuresis related to either glucose or urea. Hypotonic fluid loss resulting from fistula output and osmotic diuresis may have led to this patient's hypertonic state and critical illness. The patient died on hospital day 11 as a result of widely disseminated cancer. HHNC arises most often as a complication of non-insulin-dependent diabetes. It is also a major complication resulting from hypertonicity related to glucose intolerance or other conditions that can occur in patients receiving TPN therapy. The underlying cause of the hyperosmolar state appears to be dehydration.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Hyperosmolar, hyperglycemic, nonketotic coma in a patient receiving home total parenteral nutrient therapy. 310 54


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