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1

Filbin, Michael R., David F. M. Brown, and Eric S. Nadel. "Hyperglycemic hyperosmolar nonketotic coma." Journal of Emergency Medicine 20, no. 3 (April 2001): 285–90. http://dx.doi.org/10.1016/s0736-4679(01)00283-9.

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2

Pope, Dana W., and David Dansky. "Hyperosmolar Hyperglycemic Nonketotic Coma." Emergency Medicine Clinics of North America 7, no. 4 (November 1989): 849–57. http://dx.doi.org/10.1016/s0733-8627(20)30320-5.

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3

Kitabchi, Abbas E., and Mary Beth Murphy. "Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic Nonketotic Coma." Medical Clinics of North America 72, no. 6 (November 1988): 1545–63. http://dx.doi.org/10.1016/s0025-7125(16)30721-0.

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4

Graves, Leland. "Diabetic ketoacidosi and hyperosmolar hyperglycemic nonketotic coma." Critical Care Nursing Quarterly 13, no. 3 (November 1990): 50–61. http://dx.doi.org/10.1097/00002727-199011000-00009.

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5

Leske, JS. "Hyperglycemic hyperosmolar nonketotic coma: a nursing care plan." Critical Care Nurse 5, no. 5 (September 1, 1985): 49–56. http://dx.doi.org/10.4037/ccn1985.5.5.49.

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6

Amundson, Capt Dennis E., CDR John C. Olsen, and CDR David S. Wade. "Partial central diabetes insipidus complicating nonketotic hyperglycemic hyperosmolar coma." Journal of the American Osteopathic Association 96, no. 10 (October 1, 1996): 603. http://dx.doi.org/10.7556/jaoa.1996.96.10.603.

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7

Nakano, Toru, Go Miyata, Ko Onodera, Hirofumi Ichikawa, Takashi Kamei, Tohru Hoshida, Hiroshi Kikuchi, Keiichi Jingu, and Noriaki Ohuchi. "Hyperosmolar hyperglycemic nonketotic coma after chemoradiotherapy for esophageal cancer." Esophagus 11, no. 4 (November 2, 2013): 273–76. http://dx.doi.org/10.1007/s10388-013-0405-5.

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8

SHIMODA, Masami, Shinya YAMADA, Masaki SHINODA, Shinri ODA, Mitsuru HIDAKA, Isao YAMAMOTO, Osamu SATO, and Ryuichi TSUGANE. "Low-dose Dopamine Treatment of Patients in Nonketotic Hyperosmolar Hyperglycemic Coma." Neurologia medico-chirurgica 29, no. 10 (1989): 890–94. http://dx.doi.org/10.2176/nmc.29.890.

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9

Campanella, Lisa Marie, Richard Lartey, and Richard Shih. "Severe Hyperglycemic Hyperosmolar Nonketotic Coma in a Nondiabetic Patient Receiving Aripiprazole." Annals of Emergency Medicine 53, no. 2 (February 2009): 264–66. http://dx.doi.org/10.1016/j.annemergmed.2008.04.002.

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10

Seki, Shuji. "Clinical features of hyperosmolar hyperglycemic nonketotic diabetic coma associated with cardiac operations." Journal of Thoracic and Cardiovascular Surgery 91, no. 6 (June 1986): 867–73. http://dx.doi.org/10.1016/s0022-5223(19)35965-3.

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11

Ellis, Eileen N. "Concepts of Fluid Therapy in Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic Nonketotic Coma." Pediatric Clinics of North America 37, no. 2 (April 1990): 313–21. http://dx.doi.org/10.1016/s0031-3955(16)36870-5.

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12

SEKI, S. "Clinical Features of Hyperosmolar Hyperglycemic Nonketotic Diabetic Coma Associated with Cardiac Operations." Survey of Anesthesiology 31, no. 1 (February 1987): 2. http://dx.doi.org/10.1097/00132586-198702000-00002.

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13

GOTTSCHALK, MICHAEL E., SIMON P. ROS, and W. PATRICK ZELLER. "The emergency management of hyperglycemic-hyperosmolar nonketotic coma in the pediatric patient." Pediatric Emergency Care 12, no. 1 (February 1996): 48–51. http://dx.doi.org/10.1097/00006565-199602000-00014.

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14

Khan, Ihsan, Viswanath Vasudevan, Farhad Arjomand, Rana Ali, and Saleem Shahzad. "Quetiapine Induced Fatal Neuroleptic Malignant Syndrome(NMS) and Hyperosmolar Hyperglycemic Nonketotic Coma (HHNC)." Chest 140, no. 4 (October 2011): 113A. http://dx.doi.org/10.1378/chest.1114380.

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15

Murao, Yoshinori, Seiji Miyamoto, Yoshimasa Nosaka, Masami Imanishi, Kazuhiro Masui, Shiro Ueda, and Yuji Inada. "Hyperosmolar Hyperglycemic Nonketotic Coma (HHNC) Accompanied with Acute Renal Failure, Rhabdomyolysis and Acute Obstructive Hydrocephalus." Nihon Kyukyu Igakukai Zasshi 11, no. 4 (2000): 179–85. http://dx.doi.org/10.3893/jjaam.11.179.

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16

Singh, Balraj, Parminder Kaur, Nicole Majachani, Prem Patel, Ro-Jay Romor Reid, and Michael Maroules. "COVID-19 and Combined Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar Nonketotic Coma: Report of 11 Cases." Journal of Investigative Medicine High Impact Case Reports 9 (January 2021): 232470962110212. http://dx.doi.org/10.1177/23247096211021231.

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We report 11 cases of combined diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar nonketotic coma (HHNK) in coronavirus 2019 patients who presented to our institution in New Jersey, USA. The median age was 47 years (range 12-88 years). Out of the 11 patients, 7 were male and 4 were female. Out of 11 patients, 8 had type 2 diabetes mellitus (DM), 2 had undiagnosed DM, and 1 had type 1 DM. Presenting complaints included altered mental status, weakness, shortness of breath, cough, fever, vomiting, abdominal pain, chest pain, and foot pain. Out of 11 patients, pneumonia was diagnosed at presentation in 8 patients, while in 3 patients, chest X-ray was clear. Median value of initial glucose on presentation was 974 mg/dL (range 549-1556 mg/dL), and hemoglobin A1c on presentation was 13.8%. The median value of anion gap was 34 mEq/L. Out of the 11 patients, ketonemia was moderate in 6 patients, large in 3, and small in 2 patients. Acute kidney injury (AKI) occurred in 9 patients and 2 patients required renal replacement therapy. Out of the 11 patients, 6 required mechanical ventilation and 7 patients died. All the 6 patients requiring mechanical ventilation died. Our case series shows COVID-19 infection can precipitate acute metabolic complications in known DM patients or as first manifestation in undiagnosed DM patients. Patients can present with DKA/HHNK symptoms and/or respiratory symptoms. Mechanical ventilation is a poor prognostic factor. Further studies are needed to characterize prognostic factors associated with mortality in this vulnerable patient population.
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17

Magner, P. O., and M. L. Halperin. "Effect of metabolic acidosis on glucose reabsorption in rats with acute hyperglycemia." Canadian Journal of Physiology and Pharmacology 68, no. 1 (January 1, 1990): 79–83. http://dx.doi.org/10.1139/y90-011.

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The rate of reabsorption of glucose in the kidney is a factor to consider with respect to the degree of hyperglycemia in poorly controlled diabetics. The rate of reabsorption of glucose in the proximal tubule is driven by the electrochemical gradient for sodium across the luminal membrane. This gradient in the proximal tubule is also used to reabsorb a number of other substances, quantitatively the most important being bicarbonate. We wished to explore the hypothesis that acidosis, by reducing the filtered load of bicarbonate and therefore the reabsorption of bicarbonate in the proximal tubule, might permit an increased rate of reabsorption of glucose. Hyperglycemia was induced in rats by the infusion of hypertonic glucose. Reabsorption of glucose was measured by clearance methods and factored for glomerular filtration rate (GFR), which has a direct effect on the reabsorption of glucose. The reabsorption of glucose was increased in the kidney when the reabsorption of bicarbonate in the proximal tubule was decreased by either HCl-induced acidosis or the administration of a carbonic anhydrase inhibitor. This effect was independent of a change in GFR and the fractional excretion of Na, factors that may also lead to changes in the reabsorption of glucose by the kidney.Key words: diabetes mellitus, hyperglycemic hyperosmolar nonketotic coma, diabetic ketoacidosis, proximal convoluted tubule, hyperglycemia, glucosuria, osmotic diuresis.
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18

G, Sruthi, Haritha H. Pillai, Nisha Ullas, Jiju V, and Elessy Abraham. "Role of Antioxidants in the Management Diabetes Mellitus." International Journal of Pharmaceutical Sciences and Nanotechnology 10, no. 4 (July 31, 2017): 3763–67. http://dx.doi.org/10.37285/ijpsn.2017.10.4.2.

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Diabetes mellitus (DM), commonly referred to as diabetes, is a group of metabolic diseases in which there are high blood sugar levels over a prolonged period. Symptoms of high blood sugar include frequent urination, increased thirst and increased hunger. If left untreated, diabetes can cause many complications. Acute complications can include diabetic ketoacidosis, nonketotic hyperosmolar coma, or death. Serious long-term complications include heart disease, stroke, chronic kidney failure, foot ulcers, and damage to the eyes. Oxidative stress plays a major role in the pathogenesis and development of complications of both types of DM. However, the exact mechanism by which oxidative stress could contribute to and accelerate the development of complications in diabetic mellitus is only partly known and remains to be clarified. On the one hand, hyperglycemia induces free radicals; on the other hand, it impairs the endogenous antioxidant defense system in patients with diabetes. Endogenous antioxidant defense mechanisms include both enzymatic and non-enzymatic pathways. Their functions in human cells are to counter balance toxic reactive oxygen species (ROS). Common antioxidants include the vitamins A, C, and E, glutathione (GSH), and the enzymes superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), and glutathione reductase (GRx). Many natural antioxidants can be used in lowering blood glucose level. This review describes the importance of natural antioxidants to be included in the diet to reduce the hyperglycemic effect.
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19

YODONAWA, Masahiko, Kazuyuki KOHNO, and Sohkichi TANAKA. "Hyperosmolar Nonketotic Coma." Neurologia medico-chirurgica 26, no. 4 (1986): 328–32. http://dx.doi.org/10.2176/nmc.26.328.

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20

Hughes-Davies, T. H. "Hyperosmolar nonketotic coma." Practical Diabetes International 2, no. 5 (September 1985): 56. http://dx.doi.org/10.1002/pdi.1960020521.

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21

O'Hanlon-Nichols, Theresa. "Hyperglycemic Hyperosmolar Nonketotic Syndrome." American Journal of Nursing 96, no. 3 (March 1996): 38–39. http://dx.doi.org/10.1097/00000446-199603000-00019.

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22

Venkatraman, R., and Sunit C. Singhi. "Hyperglycemic hyperosmolar nonketotic syndrome." Indian Journal of Pediatrics 73, no. 1 (January 2006): 55–60. http://dx.doi.org/10.1007/bf02758261.

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23

Shuster, Joel. "Trimethoprim/Sulfamethoxazole-Induced Higher-Level Gait Disorder Aggrenox-Induced Stevens-Johnson Syndrome Serum Sickness–Like Reaction to Efalizumab Fluoroquinolone-Associated Achilles Tendinitis Severe Hyperglycemic, Hyperosmolar, Nonketotic Coma in a Patient Without Diabetes Receiving Aripiprazole Antidepressant-Induced Nightmares." Hospital Pharmacy 44, no. 5 (May 2009): 379–82. http://dx.doi.org/10.1310/hpj4405-379.

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The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), discuss methods of prevention, and promote reporting of ADRs to the US Food and Drug Administration's (FDA's) MedWatch program (800-FDA-1088). If you have reported an interesting, preventable ADR to MedWatch, please consider sharing the account with our readers.
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24

HARDMAN, LISA, and FRAN TOPPINGS YOUNG. "Combating hyperosmolar hyperglycemic nonketotic syndrome." Nursing 31, no. 3 (March 2001): 32hn1–32hn4. http://dx.doi.org/10.1097/00152193-200131030-00010.

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25

Noda, S., A. Takao, H. Itoh, and H. Umezaki. "Opsoclonus in hyperosmolar nonketotic coma." Journal of Neurology, Neurosurgery & Psychiatry 48, no. 11 (November 1, 1985): 1186–87. http://dx.doi.org/10.1136/jnnp.48.11.1186.

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26

O'Hanlon-Nichols, Theresa. "Clinical Snapshot: Hyperglycemic Hyperosmolar Nonketotic Syndrome." American Journal of Nursing 96, no. 3 (March 1996): 38. http://dx.doi.org/10.2307/3465159.

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27

Yeddi, Ahmed, Pranav Shah, Omnia Awad, Mohamed A. Abdallah, and Ijeoma Nnodim. "Acetazolamide-Associated Hyperosmolar Hyperglycemic Nonketotic Syndrome." American Journal of Therapeutics 27, no. 6 (November 2020): e690-e692. http://dx.doi.org/10.1097/mjt.0000000000001050.

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28

Lovera González, Pablo Danielo, Rodrigo José Sánchez, Emilio Hugo Torres Sosa, Cristian Rodrigo Matto Sanchez, Cecilia Isabel Par, and Albert Rafael Barrail Hellman. "Hemiballism in nonketotic hyperosmolar hyperglycemic syndrome." Revista Virtual de la Sociedad Paraguaya de Medicina Interna 8, no. 1 (March 30, 2021): 173–77. http://dx.doi.org/10.18004/rvspmi/2312-3893/2021.08.01.173.

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29

Schlepphorst, E., and M. E. Levin. "Rhabdomyolysis Associated with Hyperosmolar Nonketotic Coma." Diabetes Care 8, no. 2 (March 1, 1985): 198–200. http://dx.doi.org/10.2337/diacare.8.2.198.

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30

Delaney, Miriam F., Ariel Zisman, and William M. Kettyle. "DIABETIC KETOACIDOSIS AND HYPERGLYCEMIC HYPEROSMOLAR NONKETOTIC SYNDROME." Endocrinology and Metabolism Clinics of North America 29, no. 4 (December 2000): 683–705. http://dx.doi.org/10.1016/s0889-8529(05)70159-6.

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31

umpierrez, Guillermo E., Mahsheed Khajavi, and Abbas E. Kitabchi. "Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar Nonketotic Syndrome." American Journal of the Medical Sciences 311, no. 5 (May 1996): 225–33. http://dx.doi.org/10.1016/s0002-9629(15)41700-8.

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32

RIMAILHO, ALAIN, BRUNO RIOU, ERIC DADEZ, CHRISTIAN RICHARD, and PHILIPPE AUZEPY. "Prognostic factors in hyperglycemic hyperosmolar nonketotic syndrome." Critical Care Medicine 14, no. 6 (June 1986): 552–54. http://dx.doi.org/10.1097/00003246-198606000-00007.

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33

Umpierrez, Guillermo E., Mahsheed Khajavi, and Abbas E. Kitabchi. "Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar Nonketotic Syndrome." American Journal of the Medical Sciences 311, no. 5 (May 1996): 225–33. http://dx.doi.org/10.1097/00000441-199605000-00006.

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34

Matsumura, Kiichiro, Masahiro Sonoh, Akira Tamaoka, and Manabu Sakuta. "Syndrome of opsoclonus-myoclonus in hyperosmolar nonketotic coma." Annals of Neurology 18, no. 5 (November 1985): 623–24. http://dx.doi.org/10.1002/ana.410180521.

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35

Lin, Jen-Jar, Daniel W. McKenney, Cathy Price, Ray R. Morrison, and William E. Novotny. "Continuous venovenous hemodiafiltration in hypernatremic hyperglycemic nonketotic coma." Pediatric Nephrology 17, no. 11 (November 1, 2002): 969–73. http://dx.doi.org/10.1007/s00467-002-0947-6.

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36

YILDIZ, Mustafa, Çetin GÜL, and Gültaç ÖZBAY. "Hyperosmolar hyperglycaemic nonketotic coma associated with acute myocardial infarction." Acta Cardiologica 57, no. 4 (August 1, 2002): 271–74. http://dx.doi.org/10.2143/ac.57.4.2005425.

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37

Tuna, Mazhar Muslum, Faruk Kilinc, Zafer Pekkolay, Hikmet Soylu, and Alpaslan Kemal Tuzcu. "A case of mediastinitis accompanied with hyperosmolar nonketotic coma." Turkish Journal of Emergency Medicine 16, no. 2 (June 2016): 75–76. http://dx.doi.org/10.1016/j.tjem.2015.04.001.

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38

Balzan, M., and J. M. Cacciottolo. "Neuroleptic Malignant Syndrome Presenting as Hyperosmolar Non-ketotic Diabetic Coma." British Journal of Psychiatry 161, no. 2 (August 1992): 257–58. http://dx.doi.org/10.1192/bjp.161.2.257.

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A 50-year-old man presented with hyperosmolar nonketotic diabetic coma associated with the neuroleptic malignant syndrome (NMS) after intramuscular treatment with haloperidol. It is suggested that NMS may occur as a complication of uncontrolled diabetes mellitus with dehydration. Conversely, NMS might precipitate diabetic coma in patients with previously well controlled blood glucose.
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39

Arabacı, Melike, Nuray Doğan, Mustafa Tokdemir, Adnan Güçlü, Haluk Mergen, and Kurtuluş Öngel. "Hyperosmolar hyperglycemic nonketotic syndrome in a Turkish family medicine clinic." Opsta medicina 20, no. 1-2 (2014): 52–54. http://dx.doi.org/10.5937/opmed1402052a.

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40

Bala, Marta I., Anibal Chertcoff, Miguel Saucedo, Fabio Gonzalez, Luis A. Miquelini, Pablo Bonardo, and Ricardo Reisin. "Teaching NeuroImages: Nonketotic hyperglycemic hyperosmolar state mimicking acute ischemic stroke." Neurology 95, no. 18 (August 14, 2020): e2600-e2601. http://dx.doi.org/10.1212/wnl.0000000000010649.

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41

McCombs, Darlene G., Susan J. Appel, and Marcie E. Ward. "Expedited diagnosis and management of inpatient hyperosmolar hyperglycemic nonketotic syndrome." Journal of the American Association of Nurse Practitioners 27, no. 8 (August 2015): 426–32. http://dx.doi.org/10.1002/2327-6924.12205.

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42

Tiras, Sinan, Vincent Haas, Laurent Chevret, Marion Decobert, Anne Buisine, Denis Devictor, Philippe Durand, and Pierre Tissières. "Nonketotic Hyperglycemic Coma in Toddlers After Unintentional Methadone Ingestion." Annals of Emergency Medicine 48, no. 4 (October 2006): 448–51. http://dx.doi.org/10.1016/j.annemergmed.2006.02.023.

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43

Akcakus, Mustafa, Turkan Patiroglu, Mehmet Keskin, Esat Koklu, and Ali Gozukucuk. "Nonketotic Hyperosmolar Coma Associated With Splenic Rupture in Congenital Afibrinogenemia." Journal of Pediatric Hematology/Oncology 26, no. 10 (October 2004): 668–71. http://dx.doi.org/10.1097/01.mph.0000142490.72040.23.

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44

Green, D. A. "Nonketotic Hyperosmolar Diabetic Coma in an Infant with down Syndrome." Clinical Pediatrics 38, no. 5 (June 1999): 317–18. http://dx.doi.org/10.1177/000992289903800517.

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45

Azam, H., R. W. Newton, A. D. Morris, and C. J. Thompson. "Hyperosmolar nonketotic coma precipitated by lithium-induced nephrogenic diabetes insipidus." Postgraduate Medical Journal 74, no. 867 (January 1, 1998): 39–41. http://dx.doi.org/10.1136/pgmj.74.867.39.

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46

Balasubramaniyam, Nivas, Chandrasekar Palaniswamy, Virusankulam K. Rajamani, Gopalakrishnan Subbiah, Jayageetha Nivas, and Dhana R. Selvaraj. "Hyperosmolar Hyperglycemic Nonketotic Syndrome Presenting With Hemichorea-Hemiballismus: A Case Report." Journal of Neuropsychiatry and Clinical Neurosciences 23, no. 3 (January 2011): E16—E17. http://dx.doi.org/10.1176/jnp.23.3.jnpe16.

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47

ROSENTHAL, NORMAN R., and EUGENE J. BARRETT. "An Assessment of Insulin Action in Hyperosmolar Hyperglycemic Nonketotic Diabetic Patients." Journal of Clinical Endocrinology & Metabolism 60, no. 3 (March 1985): 607–10. http://dx.doi.org/10.1210/jcem-60-3-607.

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48

Shuster, Joel. "Heparin-Induced Thrombocytopenia; Hepatotoxicity with Newer Diabetes Agent; Acute Myocardial Infarction Associated with Albuterol; Olanzapine-Induced Hyperglycemic Hyperosmolar Nonketotic Coma; Paronychia and Skin Hyperpigmentation Due to Gefitinib; Selective Serotonin Reuptake Inhibitor-Induced Enuresis; Do Antidepressants Confer a Decreased Risk for Myocardial Infarction?; Recent Adverse Event Reviews; An Online Interview Discussing the Reduction of ADRs." Hospital Pharmacy 40, no. 1 (January 2005): 18–22. http://dx.doi.org/10.1177/001857870504000103.

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49

Fujioka, Masayuki, Kazuo Okuchi, Hideaki Iwanaga, and Toshisuke Sakaki. "Acute obstructive hydrocephalus due to brain-stem edema caused by hyperosmotic insult." Journal of Neurosurgery 81, no. 4 (October 1994): 627–28. http://dx.doi.org/10.3171/jns.1994.81.4.0627.

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✓ The case of a 63-year-old man with acute obstructive hydrocephalus is presented. To the authors' knowledge, this is the first reported case of acute obstructive hydrocephalus associated with nonketotic hyperosmolar diabetic coma. It is believed that the plasma hyperosmolality resulted in osmotic endothelial injury leading to brain-stem edema.
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50

Amin, Ami, Bhavika Gandhi, Steven Torre, Alireza Amirpour, Jennifer Cheng, Mayurkumar Patel, and Mohammad A. Hossain. "Rhabdomyolysis-Induced Acute Kidney Injury in Diabetic Emergency: Underdiagnosed and an Important Association to Be Aware of." Case Reports in Medicine 2018 (October 31, 2018): 1–3. http://dx.doi.org/10.1155/2018/4132738.

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Rhabdomyolysis is a potentially life-threatening clinical syndrome associated with muscle injury which can cause a leakage of intracellular contents, manifested from the range of being asymptomatic to a life-threatening condition causing acute kidney injury and severe electrolyte abnormalities. Rhabdomyolysis has been associated with both diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic nonketotic syndrome, though there is an increased association with rhabdomyolysis and acute kidney injury with hyperosmolar nonketonic state compared with patients with diabetic ketoacidosis. Common clinical manifestations are muscle pain, dark urine, and generalized weakness. The causes of rhabdomyolysis are broadly categorized into three groups: traumatic, nontraumatic exertional, and nontraumatic nonexertional. Here, we present a case of rhabdomyolysis-induced acute kidney injury in a patient with hyperosmolar hyperglycemic state. The patient was discharged on insulin and needed intermittent dialysis for two months. Our case highlights the importance of the rare association of rhabdomyolysis causing acute kidney injury in a diabetic emergency.
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