Commentary on Extreme Hyperglycemia in an Elderly Patient.
Commentary on Extreme Hyperglycemia in an Elderly Patient.
复制标题
老年患者极度高血糖的评论。
DOI：
10.1093/clinchem/hvaa331
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发表时间：
2021
影响因子：
9.3
通讯作者：
Tremblay,EliseSchlissel
中科院分区：
文献类型：
--
作者：
Tremblay,EliseSchlissel
Hyperglycemic hyperosmolar state (HHS) is a rare, lifethreatening complication of impaired glucose metabolism (1). Although the precise diagnosis of HHS is often evident from laboratory criteria, there is some overlap in the features of this condition with those of diabetic ketoacidosis (DKA). Therefore, the clinician must exercise caution in determining the appropriate diagnosis and initiating life-saving treatment. Distinguishing features include the degree of hyperglycemia (higher in HHS) and ketosis (higher in DKA), type of diabetes (HHS more common in Type 2 diabetes), and plasma osmolality (higher in HHS). In this case, the patient presented with significant hyperglycemia, moderately increased ketones, and increased calculated osmolality. Her age and known prediabetes made HHS due to Type 2 diabetes a more likely diagnosis; however, the clinician must consider both possibilities, especially given the degree of ketosis. Existing criteria do not specify a threshold of ketonemia to differentiate between HHS and DKA (2). Notably, some patients with Type 2 diabetes are more prone to developing ketones, leading to further overlap between diagnostic criteria. However, in the case of
