Hypermolar syndrome due to hyperglycemia

Hypermolecular hyperglycemia syndrome is a metabolic complication of diabetes characterized by a severe increase in blood glucose, severe dehydration, hypermolecular hyperplasia in the blood plasma and increased awareness of alertness and lethargy. Type II diabetes mellitus is often felt during stress and is diagnosed with hyperglycemia, hypermolecular hyperplasia and no significant increase in ketone. It is treated with saline and intravenous insulin. Complications include: coma, death.

The hypermolecular syndrome with hyperglycemia has a mortality rate of up to 20%, well above the mortality rate of diabetic ketoacidosis (DKA), an increase in ketones in the blood due to an increase in the rate of sugar, less than 1%.

This syndrome is the result of a period of hyperglycemia that is not enough to treat certain liquids, because the increase in blood sugar level causes osmosis "which increases the amount of urine".

Some factors accelerate the onset of this syndrome, including:

• Acute infections and other medical conditions.
• Drugs that weaken glucose therapy "restore it to a normal level", or increase the loss of fluid in the urine, such as diuretics.
• Neglecting the treatment of diabetes.

There are no ketones in plasma patients with type II diabetes, as their amount of insulin is sufficient to prevent the formation of ketones.

As there is no acidity in the body, most of these patients have a long period of osmotic dehydration, a "hypoglycemia", so that blood glucose is greater than 600 mg / dl and the osmolar level is higher at 320 mOsm / L. Higher than in the case of diabetic ketoacidosis, "increase in the number of ketones in the blood due to an increase in the sugar level".

Symptoms of hypermolecular syndrome

One of the most important symptoms of this syndrome: the fluctuation of consciousness between confusion and disobedience to coma, and usually results from a severe drought, accompanied by an asterism 'increase in nitrogen in the blood "or not. Symptoms include increased blood sugar and osmolality.

Unlike ACD, a seizure can occur in a particular part of the brain, or a general crisis, in addition to the possibility of temporary paralysis.

Diagnostic

The diagnosis consists in knowing:

• Level of sugar in the blood.
• Osmolality ratio in the plasma.

The patient may be exposed to this syndrome if there is an increase in blood sugar when obtaining a sample of blood taken from the finger during different periods of his mental state.

You should also measure the proportion of urea, sugar, creatinine, ketones, osmolarity rate in the plasma and note whether ketones exist in the urine or not, and the level of Potbadium is normal, but sodium varies between size and decrease depending on the amount of imbalance occurring. Therefore, hyperglycemia causes sodium hypoglycemia due to dilution of water, but it regulates the sodium level by adding 1.6 mEq per 100 mg / dL increase in blood sugar .

The blood level of urea and creatinine increases dramatically, and the pH in this case is greater than 7.3, and acidic acidity is often caused by the accumulation of lactic acid.

Fluid deficiency can reach 10 liters, which can cause severe collapse or a fall in the circulatory system, a common cause of death or coagulation of a large-scale blood clotting. Bleeding can occur as a result of blood clots forming in the blood vessels. Other complications such as: pneumonia, acute renal failure, severe respiratory distress syndrome.

Treatment of hypermolecular syndrome

• An injection into a vein containing 0.9% saline solution.
• Treatment of potbadium deficiency.
• Intravenous insulin infusion (as long as the potbadium is greater than or equal to 3.3 mEq / L

The treatment comprises a solution of isotonic salt "the concentration of sodium and chloride in the solution is equal to that of normal human blood" at 15 to 20 mL / kg / h during the first hours, after which the modified sodium ratio must be calculated "due to deficiency or increase in sodium" The sodium level after setting is less than 135 mEq / L (135 mmol / L) and then the saline solution must be between 250 and 500 mL / h.

However, if the sodium level is normal or slightly higher, the saline solution receives 0.45%. "Its concentration is equal to half that of normal blood." When the glucose level reaches 250: 300 mg / dL, the patient should receive dextrose. The flow rate of fluid administered to the patient depends on the blood pressure, his heart condition and the balance between the donated fluids and lost.

Insulin is administered intravenously at 0.1 unit / kg after giving the first liter of saline. Sometimes hypoglycemia causes the fall of plasma, so reduce the amount of insulin administered to the patient, which can cause brain edema: the fluid accumulates in the brain and around it this.

People with this type of diabetes often need a higher dose of insulin and the amount of insulin administered at a rate of 1 to 2 units / h should be reduced when the sugar level in the blood reaches 300 mg / dL. By darkening, the patient becomes able to eat.

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Translated by Mahmoud Marzouk

Audit: Mohammed Safti

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