Journal of Anesthesia & Clinical Care Category: Clinical Type: Case Report
Wide Spread Arterial and Venous Thrombosis in a Case of Hyperglycemic Hyperosmolar State (HHS)
- Ganaw A1*, Shaikh N1, Marcus AE1, Soekarman D2
- 1 Department Of Anesthesia, ICU And Perioperative Medicine, Hamad Medical Corporation, Weil Cornell Medical College, Doha, Qatar
- 2 Department Of Internal Medicine, Hamad Medical Corporation, Weil Cornell Medical College, Doha, Qatar
*Corresponding Author:Ganaw A
Department Of Anesthesia, ICU And Perioperative Medicine, Hamad Medical Corporation, Weil Cornell Medical College, Doha, Qatar
Received Date: Mar 26, 2018 Accepted Date: Apr 30, 2018 Published Date: May 14, 2018
A case is presented with a patient in a Hyperglycemic Crisis (HC), complicated by widespread thrombo ischemia including the left upper and lower limb, and the aortic arch. Extreme hyperglycemia and dehydration added to the pro-thrombotic state of diabetes and resulted in lower limb ischemia with ultimate limb loss. Current guidelines provide for thrombo-prophylaxis against Deep Venous Thrombosis (DVT) in HHS. Further development of the guidelines is needed to cover the risk of an arterial thrombosis as well.
Diabetes mellitus is regarded as a pro-thrombotic state . Extreme hyperglycemia and dehydration in the Hyperglycemic Hyperosmolar State (HHS), a subtype of Hyperglycemic Crisis (HC), add to the risk for thrombo-ischemic events . Lower limb ischemia and occlusion of the femoral arteries in HHS is a distinct association, but its development may be hard to recognize due to its infrequent occurrence in daily practice [3,4]. Prompt recognition is important, since the window of opportunity to prevent irreversible damage is narrow. For teaching purposes, the following case is reported.
|Characterstics||Clinical Parameters||Normal Range|
|Heart rate||126 beats/min|
|Blood pressure||93/40 mm Hg.|
|Resp. rate||28 breaths/min||normal range|
|Blood sugar||84.4 mmol/L||3.3-5.5 mmol/L|
|Calculated osmolarity||348.4 mOsm/Kg||275-295 mOsm/Kg|
|Sodium||132 mmol/L||135-145 mmo/L|
|Urea||18 mmol/L||2.5-7.1 mmol/L|
|Creatinine||312 µmol/L||50-98 µmol/L|
|Serum Lipase||1400 IU/L||13-60 IU/L|
Figure 1: CT angiogram is showing subclavian artery thrombosis.
Figure 2: CT Angiogram is showing Aortic arch thrombosis.
Figure 3: CT angiogram is showing Aortic arch thrombosis.
Figure 4: CT angiogram is showing Aortic arch and Subclavian artery thrombosis.
|Item (Normal range)||Day 1||Day 2||Day 3||Day 4||Day 5||Day 6||Day 7||Day 8|
|D-Dimer (less than 0.46 mg/L)||4.48||23.26||35.2|
|Fibrinogen (1.8-3.5 g/L)||2.6||2.3||2.2|
Figure 5: MRI is showing cerebellar infarction.
Figure 6: CT scan is showing cerebellar infarction.
Figure 7: CT Angiogram is showing mesenteric vein thrombosis.
Figure 8: Coagulation during stay in intensive care unit.
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Citation:Ganaw A, Shaikh N, Marcus AE, Soekarman D (2018) Wide Spread Arterial and Venous Thrombosis in a Case of Hyperglycemic Hyperosmolar State (HHS). J Anesth Clin Care. 5: 027.
Copyright: © 2018 Ganaw A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.