Unusual clinical course, Unusual or unexpected effect of treatment
Daniel Varela, Natalie Held, Stuart Linas
Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
Am J Case Rep 2018; 19:562-566
Hyperglycemic crises can cause severe neurologic impairment. One of the most dreaded consequences of hyperglycemic crises is cerebral edema, a rare complication seen during the treatment of hyperglycemic crises resulting from overly-aggressive fluid resuscitation and rapid correction of hyperglycemia and hyperosmolarity.
CASE REPORT: We present a case of profound hyperglycemic crisis with blood glucose greater than 2000 mg/dL, complicated by the development of new neurologic deficits after rapid correction of hyperglycemia. Brain imaging failed to reveal a diagnosis of cerebral edema or other acute intracranial process. However, the deficits did not resolve by the time of discharge, raising concern that the neurologic impairment may have been the consequence of overly-aggressive treatment of the hyperglycemic crisis.
CONCLUSIONS: Neurologic status must be monitored closely, with frequent re-examination, in patients who present with hyperglycemic crises. Care should be taken to prevent over-correction of hyperglycemia and hyperosmolarity following initial fluid resuscitation of these patients to prevent cerebral edema or other significant neurologic impairment.
Keywords: Brain Edema, Diabetic Ketoacidosis, Hyperglycemia, Hyperglycemic Hyperosmolar Nonketotic Coma, Hypernatremia