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Japanese

A CASE OF NONKETOTIC HYPEROSMOLAR HYPERGLYCEMIA FOLLOWING INTRAVENOUS ADMINISTRATION OF GLYCEROL Junichi Masuda 1 , Katsuya Nishimaru 1 1Division of Neurology, First Department of Internal Medicine, School of Medicine, Fukuoka University pp.293-297
Published Date 1980/3/1
DOI https://doi.org/10.11477/mf.1406204557
  • Abstract
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A case of nonketotic hyperosmolar hyperglycemia following intravenous administration of glycerol for cerebral edema are discribed.

A 65 years old, right-handed, hypertensive man experienced an episode of distrubance of conscious-ness and right hemiplegia. CT scan revealed intra-cerebral hemorrhage perforating to ventricular and subarachnoid space (left lateral type). 1000 m/ of 10% glycerol was administered each day since May 26 for 6 days for cerebral edema. Blood sugar beganto elevate on May 30 and continued to elevate until 825 mg/dl on June 1. At the same time serum sodium concentration was 172 mEq/l, and ketone bodies were negative in the urine, and BUN was 60 mg/dl. These data revealed nonketotic hyperosmolar hyperglycemia.

Glycerol administration was discontinued, and 40 unit regular insulin was administered totally. Then blood sugar decreased till 139 mg/dl. Serum sodium concentration and BUN decreased gradually, and they became normal on June 6. Blood sugar became possible to be controlled by means of 20 unit lente insulin a day.

Possible mechanism of nonketotic hyperosmolar hyperglycemia in this case is as follows;

1) Diabetes mellitus existed prior to cerebro-vascular episode in this case because 50 g glucosetolerance test and immuno-reactive insulin response revealed diabetic pattern on the good controlled state.

2) Gluconeogenesis by glycerol was the strong stimulation towards hyperglycemia.

3) Dehydration action of glycerol suppressed the insulin secretion and the production of ketone bodies.

This case is the fifth case of nonketotic hyper-osmolar hyperglycemia following glycerol adminis-tration and the first case among the patients administered intravenously. Careful observation of blood sugar and electrolytes during glycerol admin-istration is important for old patient with diabetes mellitus.


Copyright © 1980, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 2185-405X 印刷版ISSN 0006-8969 医学書院

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