Abdominal pain in patients with hyperglycemic crises☆
Section snippets
Materials and methods
This was a prospective evaluation of 200 consecutive patients with hyperglycemic crises admitted to Grady Memorial Hospital in Atlanta during a 13-month period starting in October 1995. Of the 200 patients, 189 patients (95%) met the diagnostic criteria for DKA (111 men and 82 women) and 11 patients were admitted with HHS (4 men and 7 women). The diagnosis of DKA was established in the emergency department by a plasma glucose level greater than 13.8 mmol/L (250 mg/dL), a serum bicarbonate level
Results
The study population included 189 patients with DKA and 11 patients with HHS. Their clinical characteristics are shown in Table 1. Abdominal pain was reported in 86 of 189 patients with DKA (46%). Patients with DKA and abdominal pain were younger (37 ±; 1 yr, standard error of mean) than patients without abdominal pain (41 ± 2 yr, P = .03). The mean duration of diabetes and number of patients with newly diagnosed diabetes were similar between DKA patients with and without abdominal pain. Pain
Discussion
The evaluation of abdominal pain in patients with DKA may be difficult and frequently challenges the physicians' clinical acumen. Faced with a seriously ill patient, the clinician must judge whether the abdominal pain is a consequence of the metabolic decompensation or if the pain signals a serious underlying intra-abdominal process that may have precipitated the development of ketoacidosis. Because of the fear of missing an intra-abdominal medical or surgical process, extensive laboratory and
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Address reprint requests to Guillermo E. Umpierrez, MD, Associate Professor of Medicine, Department of Medicine, University of Tennessee Health Science Center, 951 Court Ave, Rm 340M, Memphis, TN 38163.