Calibre systems hhs9/7/2023 ![]() Hyperosmolar therapy can be considered but requires frequent monitoring of electrolytes and osmolarity. More evidence is needed, but it is reasonable to initiate tailored treatment to avoid osmolarity reduction rates exceeding the hypernatraemia-based limit of 24 mOsm/l/day. The concomitant presence of DKA and HHS leads to a treatment dilemma with a high risk of excessive osmolarity shifts. Hyperosmolar therapy (NaCl 3%) was initiated to mitigate the risk of potentially fatal cerebral osmotic shifts. The recommended treatment with simultaneous insulin and volume repletion was followed but resulted in an excessively rapid decline in serum osmolarity. ![]() Despite the high prevalence of this combination, recommended treatments from leading guidelines may not be compatible with the clinical picture.Ī 36-year-old man presented with explicit concurrent HHS and DKA. Hyperglycaemic hyperosmolar state (HHS) and diabetic ketoacidosis (DKA) features can occur simultaneously in 27% of diabetic emergencies and have a two-fold increased risk of death. ![]() This case supports the hypothesis that this type of vasculitis could be related to the occurrence of pulmonary embolism. Extensive diagnostic work-up was performed to identify an alternative cause of pulmonary thromboembolism however, the investigations were negative. Giant cell arteritis was diagnosed and treated with prednisolone, with complete resolution of symptoms. Three weeks after the initial diagnosis the headache still persisted and she developed scalp tenderness. Anticoagulation with edoxaban was started after 5-day bridging with enoxaparin. She had no changes on physical examination, but work-up tests showed increased D-dimer levels and computed tomography pulmonary angiography revealed signs of a chronic/subacute embolism in the right inferior lobe. We report the case of a 79-year-old woman with a history of polymyalgia rheumatica, who presented with left thoracic pain radiating to the neck and scapula plus temporal headache. An increased risk of venous thromboembolism has been described in these patients. ![]() Giant cell arteritis is the most common type of systemic vasculitis. ![]()
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