Document Detail

Hyperosmolar hyperglycemic state in advanced amyotrophic lateral sclerosis.
MedLine Citation:
PMID:  21126160     Owner:  NLM     Status:  In-Data-Review    
Abstract Our objective was to describe cases of hyperosmolar hyperglycemic state (HHS) in advanced amyotrophic lateral sclerosis (ALS) patients and discuss its pathophysiology. Five ventilator-dependent patients with ALS, with no previous history of diabetes, showed development of marked hyperglycemia (plasma glucose levels of 755-1544 mg/dl) after preceding infectious episodes. All patients had severe generalized muscle wasting and tetraplegia. The initial manifestations of HHS were fever, drowsiness, or polyuria. Hydration and intravenous insulin therapy were markedly effective, resulting in favorable recovery without the necessity of chronic medication for hyperglycemia in all cases. Seventy-five grams oral glucose tolerance tests performed via feeding tubes in two patients after the successful treatment of HHS revealed increased insulin resistance and diminished early-phase insulin secretion with preserved total insulin secretion. In conclusion, a marked loss of skeletal muscle, the largest glucose consumer of the human body, with background abnormality of early-phase insulin secretion, might be a causative factor of HHS in advanced ALS.
Toshio Shimizu; Masayuki Honda; Takuya Ohashi; Motoyoshi Tsujino; Utako Nagaoka; Akihiro Kawata; Kazuhiko Watabe; Shiro Matsubara; Hideaki Hayashi
Publication Detail:
Type:  Journal Article     Date:  2010-12-02
Journal Detail:
Title:  Amyotrophic lateral sclerosis : official publication of the World Federation of Neurology Research Group on Motor Neuron Diseases     Volume:  12     ISSN:  1471-180X     ISO Abbreviation:  Amyotroph Lateral Scler     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-06-27     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101283386     Medline TA:  Amyotroph Lateral Scler     Country:  England    
Other Details:
Languages:  eng     Pagination:  309-11     Citation Subset:  IM    
Department of Neurology, Tokyo Metropolitan Neurological Hospital , Tokyo.
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