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hyperglycemia

Etiology: 1) diabetes mellitus 2) pre-diabetes 3) pharmaceuticals [6] a) atypical antipsychotics b) beta-blockers c) calcium channel blockers (overdose) c) glucocorticoids d) diuretics: thiazide diuretics & loop diuretics e) antiretroviral agents - antiretroviral protease inhibitors - nucleoside reverse transciptase inhibitors f) immunosuppressive agents - cyclosporine - tacrolimus g) niacin h) quinolones i) statins Epidemiology: - hospital admission for hypoglycemia now exceed those for hyperglycemia among older adults [7] Pathology: 1) impaired insulin secretion 2) diminished tissue responsiveness to insulin 3) immunological distubances: a) abnormalities in granulocyte adherence, chemotaxis, phagocytosis & microbicidal function b) inhibition of attachment of complement C3 to microbial surfaces 4) inactivation of bisphosphoglycerate mutase via glycation of Lys-159, may disrupt regulation of hemoglobin oxygen affinity (predicted increase in hemoglobin O2 affinity) Clinical manifestations: - urinary frequency, polyuria - increased thirst - also see diabetes mellitus Laboratory: - serum glucose increase - urine glucose: glycosuria (+/-) - assume diabetes mellitus a) hemoglobin A1c to assess long-term glycemic control b) urine microalbumin: early stages of diabetic nephropathy c) lipid panel Management: - see glycemic control & diabetes mellitus

Related

diabetes mellitus glucose in serum/plasma hypoglycemia

Specific

hyperglycemic-hyperosmolar syndrome; hyperglycemic-hyperosmolar nonketotic coma (HHNC) postprandial hyperglycemia

General

sign/symptom

References

  1. Harrison's Principles of Internal Medicine, 13th ed. Companion Handbook, Isselbacher et al (eds), McGraw-Hill Inc. NY, 1995, pg 830
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, 17. 18 American College of Physicians, Philadelphia 1998, 2015, 2018.
  3. Prescriber's Letter 9(1):4 2002
  4. Prescriber's Letter 13(4): 2006 Inpatient Management of Hyperglycemia Detail-Document#: 220412 (subscription needed) http://www.prescribersletter.com
  5. Henry's Clinical Diagnosis & Management by Laboratory Methods, 21st edition, McPherson RA & Pincus MR (es), W.B. Saunders Co., Philadelphia, PA. 2007, page 160
  6. Prescriber's Letter 21(5): 2014 Drugs That Significantly Increase Blood Glucose Detail-Document#: 300508 (subscription needed) http://www.prescribersletter.com
  7. Lipska KJ, Ross JS, Wang Y et al. National trends in US hospital admissions for hyperglycemia and hypoglycemia among Medicare beneficiaries, 1999 to 2011. JAMA Intern Med. 2014;174(7):1116-1124 PMID: 24838229
  8. Inzucchi SE. Clinical practice. Management of hyperglycemia in the hospital setting. N Engl J Med. 2006 Nov 2;355(18):1903-11. Review. PMID: 17079764