RESUMEN
RATIONALE: Bertolotti syndrome (BS) is characterized by radiculopathy caused by structural anomalies. Despite the structural deformity, conservative treatment is predominantly recommended due to surgery-related complications. Because of the diagnosis complexity, the incidence and contributing factors of BS, remain controversial. We report the case of a patient with BS who was treated with integrative Korean medicine (IKM). Moreover, we evaluated the epidemiological characteristics of lumbosacral transitional vertebrae (LSTV) from medical records of patients diagnosed with LSTV at 4 different medical clinics of Korean medicine. PATIENT CONCERNS: A 33-year-old male patient with low back pain and severe radiculopathy was diagnosed with BS (Castellvi Type II) on magnetic resonance imaging at a local orthopedic clinic. Additionally, the medical records of patients with BS who had been treated with IKM in 4 different institutions of Korean medicine were analyzed, and the characteristics of patients suffering from BS were identified. DIAGNOSES, INTERVENTIONS, AND OUTCOMES: The patient underwent IKM treatment for 40 days as an inpatient. The patient's condition was assessed using the Euroqol 5-dimension index and Oswestry Disability Index, and symptom severity was measured using the Numeric Rating Scale. IKM was effective in improving pain and functional disability without causing any adverse effects. In a retrospective review of medical records, the study identified symptom trends reported by patients with LSTV. LESSONS: IKM demonstrates potential efficacy in BS management, with notable trends in LSTV-related symptomatology warranting further investigation.
Asunto(s)
Dolor de la Región Lumbar , Medicina Tradicional Coreana , Radiculopatía , Humanos , Masculino , Adulto , Dolor de la Región Lumbar/etiología , Dolor de la Región Lumbar/terapia , Radiculopatía/terapia , Radiculopatía/etiología , Estudios Retrospectivos , República de Corea/epidemiología , Medicina Integrativa/métodosRESUMEN
BACKGROUND: Considering that large variations exist amongst practitioners in lumbar disorder management and the significant costs that lumbar disorders incur, determining clinical practice patterns to provide preliminary data for standardization should be given higher priority. Lumbar spinal stenosis (LSS) is commonly treated using integrative non-surgical methods by Korean medicine doctors (KMDs) in Korea, and this is the first study to assess current Korean medicine practice trends for LSS. METHODS: A survey on KMD diagnosis, treatment, prognosis and decision-making in LSS treatment was developed in a 3-step procedure of preliminary drafting, revision based on extramural expert opinion, and final editing. The survey was conducted at the internal conference of a spine-specialty Korean medicine hospital on January 25th, 2015. RESULTS: The response rate was high at 79.19% (n = 118/149). Participants replied that they treated 7.3 ± 6.8 LSS patients/day using a multimodal treatment method consisting of acupuncture, pharmacopuncture, herbal medicine, Chuna manipulation, and electroacupuncture. Acupuncture mainly used Ashi points and MSAT, and pharmacopuncture mainly Shinbaro solution. The most frequently prescribed herbal medicine was Chungpa-jun, and the most commonly applied Chuna techniques were sidelying lumbar extension dysfunction correction technique, and prone lumbosacral joint distraction method. Radiological findings were mainly referred to for diagnosis, and clinical symptoms, age, radiological findings, and medical history were regarded to be important for prognosis. Participants replied that 7.8 ± 3.3 weeks were required for 50% reduction in pain, and 16.1 ± 7.7 weeks for 80% reduction. CONCLUSIONS: These results suggest that KMDs in Korea combine a conventional approach to LSS and a Korean medicine approach to low back pain for integration of empirical- and evidence-based diagnosis and treatment. The findings may contribute in bridging the divide between evidence and clinical practice guidelines for Korean medicine treatment of LSS and real-world clinical practice in future research.
Asunto(s)
Terapia Combinada , Dolor de la Región Lumbar/terapia , Estenosis Espinal/terapia , Terapia por Acupuntura , Adulto , Anciano , Femenino , Humanos , Medicina Integrativa , Dolor de la Región Lumbar/diagnóstico , Dolor de la Región Lumbar/fisiopatología , Vértebras Lumbares/fisiopatología , Masculino , Persona de Mediana Edad , Médicos , Preparaciones de Plantas/administración & dosificación , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina , República de Corea , Estenosis Espinal/diagnóstico , Estenosis Espinal/tratamiento farmacológico , Estenosis Espinal/fisiopatología , Encuestas y CuestionariosRESUMEN
ETHNOPHARMACOLOGICAL RELEVANCE: While bee venom (BV) pharmacopuncture use is common in Asia, frequent occurrence of allergic reactions during the treatment process is burdensome for both practitioner and patient. AIM OF THE STUDY: This study compared efficacy and safety in isolated and purified essential BV (eBV) pharmacopuncture filtered for phospholipase A2 (PLA2) and histamine sections, and original BV to the aim of promoting safe BV pharmacopuncture use. MATERIALS AND METHODS: In in vitro, we examined the effect of BV and eBV on nitric oxide (NO) production induced by lipopolysaccharide (LPS) in RAW 264.7 macrophages, and clinically, 20 healthy adults aged 20-40 years were randomly allocated and administered eBV 0.2mL and BV pharmacopuncture 0.2mL on left and right forearm, respectively, and physician, participant, and outcome assessor were blinded to treatment allocation. Local pain, swelling, itching, redness, wheals, and adverse reactions were recorded by timepoint. RESULTS: eBV and BV exhibited similar inhibitory effects on NO production. Also, in comparison between eBV and BV pharmacopuncture administration areas on each forearm, eBV displayed significantly lower local pain at 24h post-administration (P=0.0062), and less swelling at 30min (P=0.0198), 2 (P=0.0028), 24 (P=0.0068), and 48h post-administration (P=0.0253). eBV also showed significantly less itching at 24 (P=0.0119), 48 (P=0.0082), and 96h (P=0.0141), while redness was significantly less at 30min (P=0.0090), 6 (P=0.0005), and 24h (P<0.0001). Time-by-treatment interactions were statistically significant for itching and redness (P<0.001, and P<0.001, respectively), and all original BV pharmacopuncture administered regions showed a tendency toward more severe itching and redness in later measurements. CONCLUSIONS: eBV and BV displayed comparable anti-inflammatory effects, and eBV pharmacopuncture presented less local allergic reactions.
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Venenos de Abeja/administración & dosificación , Venenos de Abeja/inmunología , Hipersensibilidad/dietoterapia , Mordeduras y Picaduras de Insectos/tratamiento farmacológico , Mordeduras y Picaduras de Insectos/inmunología , Acupuntura/métodos , Adulto , Animales , Línea Celular , Método Doble Ciego , Femenino , Antebrazo , Humanos , Hipersensibilidad/inmunología , Lipopolisacáridos/inmunología , Macrófagos/inmunología , Masculino , Ratones , Óxido Nítrico/inmunología , Fosfolipasas A2/inmunologíaRESUMEN
OBJECTIVES: To assess medical care and costs of the 3 highest prevalence lumbar disorders-non-specific low back pain (nLBP), intervertebral disc disorder (IDD) and spinal stenosis (SS)-from national billing data to provide basic information for standards of appropriate management. DESIGN: Retrospective analysis of National Health Insurance National Patient Sample data provided by the Korean Health Insurance Review and Assessment Service (HIRA). SETTING: 2011 claims data from all medical institutions which filed billing statements to HIRA. PARTICIPANTS: A total of 135â 561 patients with lumbar disorder who received medical services during 2011. OUTCOME MEASURES: Patient characteristics, medical procedures, medication, cost, injection and surgery. RESULTS: In the nLBP and IDD groups, the 50-59 age range had the highest prevalence, whereas prevalence increased with age in SS. All 3 groups showed a higher percentage in women. The average treatment cost was 196â 552 KRW in the nLBP and 362â 050 KRW in the IDD group, and highest in the SS group at 439â 025 KRW. While in the nLBP group women spent more on medical expenses, in the other 2 groups men showed higher expenditure. Expenditure grew with age in the nLBP and SS groups, whereas that of the IDD group peaked in their 40s. Analgesics were used in 73.43% of patients with nLBP, 82.64% of patients with IDD and 86.46% of patients with SS, and opioids in 4.12% of patients with IDD and 5.36% of patients with SS. Surgery rates were highest in the SS group at 4.85%, with 0.9% for nLBP and 4.59% for IDD. The most frequent injection code was lumbar/caudal epidural nerve block. Expenditure and surgery rates were higher in the injection than in the non-injection subgroup in all 3 groups. CONCLUSIONS: Patterns of medical care of most frequent lumbar disorders from HIRA data showed significant difference between groups and provide a basic standard for future usual care guidelines linked with health policy and budget appropriation.
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Costos de la Atención en Salud/estadística & datos numéricos , Dolor de la Región Lumbar/economía , Dolor de la Región Lumbar/terapia , Programas Nacionales de Salud , Enfermedades de la Columna Vertebral/economía , Enfermedades de la Columna Vertebral/terapia , Adulto , Factores de Edad , Anciano , Estudios Transversales , Femenino , Humanos , Vértebras Lumbares , Masculino , Persona de Mediana Edad , República de Corea , Estudios Retrospectivos , Factores Sexuales , Adulto JovenRESUMEN
We investigated the range and frequency of significant adverse events (AEs) in use of pharmacopuncture and acupuncture using large-scale, single-center safety data as evidence supporting safety of acupuncture with pharmacopuncture, used extensively in Asia, is scarce. Status reports (nurse records in ambulatory and inpatient care units, and administrative event records) as a part of an internal audit at a Korean Medicine hospital specializing in the treatment of musculoskeletal disorders, patient complaints filed through the hospital website, and medical records of patients visiting from December, 2010 (inception of internal audit) to October, 2014 were retrospectively reviewed. A total 80,523 patients (5966 inpatients and 74,557 outpatients) visited during this period. Inpatients received an average 31.9â±â20.7 acupuncture, 23.0â±â15.6 pharmacopuncture, and 15.4â±â11.3 bee venom pharmacopuncture sessions, and outpatients were administered 8.2â±â12.2 acupuncture, 7.8â±â11.5 pharmacopuncture, and 10.0â±â12.3 bee venom sessions, respectively. AEs associated with acupuncture/pharmacopuncture were forgotten needle (nâ=â47), hypersensitivity to bee venom (nâ=â37), presyncopic episode (nâ=â4), pneumothorax (nâ=â4), and infection (nâ=â2). Most cases were mild requiring little or no additional intervention and leaving no sequelae. Although serious AEs including infection (nâ=â2) and anaphylaxis associated with bee venom treatment (nâ=â3) were also reported, incidence was rare at 0.002% in infection and 0.019% in anaphylaxis. Incidence of AEs associated with acupuncture/pharmacopuncture treatment was low, and most cases were not serious. Still, however rare, avoidable AEs can and should be prevented through education and corrective action. Further prospective studies on the effect of error reduction strategies on incidence of adverse effects are warranted.
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Terapia por Acupuntura/efectos adversos , Venenos de Abeja/efectos adversos , Pacientes Internos/estadística & datos numéricos , Enfermedades Musculoesqueléticas/terapia , Pacientes Ambulatorios/estadística & datos numéricos , Terapia por Acupuntura/métodos , Adulto , Anafilaxia/inducido químicamente , Hipersensibilidad a las Drogas/etiología , Registros Electrónicos de Salud , Femenino , Humanos , Masculino , Persona de Mediana Edad , Agujas/efectos adversos , Neumotórax/etiología , República de Corea , Estudios Retrospectivos , Enfermedades Cutáneas Infecciosas/etiología , Síncope/etiologíaRESUMEN
STUDY DESIGN: Prospective observational 5-year study. OBJECTIVE: To assess pain, functional disability, surgical status, and health care use of patients who actively selected complementary and alternative medicine treatment and risk factors for lumbar surgery. SUMMARY OF BACKGROUND DATA: Controversy continues regarding difference in long-term outcomes of conservative and surgical treatment. METHODS: We recruited 150 consecutive lumbar disc herniation patients with radiating pain (numeric rating scale ≥5) from November, 2006 at a Korean medicine hospital outpatient department, of which 128 patients completed 6 months of complementary and alternative medicine treatment (herbal medicine, acupuncture, bee-venom pharmacopuncture, and Chuna manipulation). Follow-up data was collected every year for 5 years. RESULTS: We assessed surgical status in 105 patients (82%), of which 8 replied that they had received surgery. Ninety-two patients (72%) attended the 5-year follow-up. Visual analog scale of back pain which was 4.19â±â2.60 at baseline improved after treatment, decreasing to 0.94â±â1.13 at 6 months, and was maintained at 1.25â±â1.81 at 5 years. Visual analog scale of leg pain decreased from 7.50â±â1.32 to 0.94â±â1.29 and was sustained at 0.98â±â1.73. Participants reported less disability with Oswestry Disability Index scores decreasing from 41.50â±â15.07 at baseline to 11.24â±â10.44 at 6 months, which then declined further to 7.61â±â9.82 at 5 years. SF-36 quality-of-life health survey scores also improved, increasing from 33.41â±â12.67 at baseline to 66.04â±â15.77 at 6 months, and reaching 75.43â±â15.79 at 5 years. In assessment of satisfaction with current state, 20% replied "highly satisfied," 67% "satisfied," 10% "fairly satisfied," and 2% "dissatisfied." Patients with younger age, previous treatment for current pain episode, and higher levels of sensory impairment and pain in the lower extremities were at higher risk of lumbar surgery. CONCLUSION: The long-term results of lumbar disc herniation patients receiving nonsurgical complementary and alternative medicine treatment were favorable and satisfaction rates were high. LEVEL OF EVIDENCE: 2.
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Degeneración del Disco Intervertebral/cirugía , Desplazamiento del Disco Intervertebral/cirugía , Vértebras Lumbares/cirugía , Adolescente , Adulto , Evaluación de la Discapacidad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Satisfacción del Paciente , Estudios Prospectivos , Factores de Riesgo , Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Symptomatic cervical intervertebral disc herniation (IDH) presenting as neck pain accompanied by arm pain is a common affliction whose prevalence continues to rise, and is a frequent reason for integrative inpatient care using complementary and alternative medicine (CAM) in Korea. However, studies on its long term effects are scarce. METHODS: A total 165 patients with cervical IDH admitted between January 2011 and September 2014 to a hospital that provides conventional and Korean medicine integrative treatment with CAM as the main modality were observed in a prospective observational study. Patients underwent CAM treatment administered by Korean medicine doctors (KMDs) in accordance with a predetermined protocol for the length of hospital stay, and additional conventional treatment by medical doctors (MDs) as referred by KMDs. Short term outcomes were assessed at discharge and long term follow-ups were conducted through phone interviews after discharge. Numeric rating scale (NRS) of neck and radiating arm pain, neck disability index (NDI), 5-point patient global impression of change (PGIC), and factors influencing long term satisfaction rates in PGIC were assessed. RESULTS: Of 165 patients who received inpatient treatment 20.8 ± 11.2 days, 117 completed the long term follow-up up at 625.36 ± 196.7 days post-admission. Difference in NRS between admission and discharge in the long term follow-up group (n = 117) was 2.71 (95% CI, 2.33, 3.09) for neck pain, 2.33 (95% CI, 1.9, 2.77) for arm pain, and that of NDI 14.6 (95% CI, 11.89, 17.32), and corresponding scores in the non-long term follow-up group (n = 48) were 2.83 (95% CI, 2.22, 3.45) for neck pain, 2.48 (95% CI, 1.84, 3.12) for arm pain, and that of NDI was 14.86 (95% CI, 10.41, 19.3). Difference in long term NRS of neck pain and arm pain from baseline was 3.15 (95% CI, 2.67, 3.64), and 2.64 (95% CI, 1.99, 3.29), respectively. PGIC was reported to be "satisfactory" or higher in 79.5% of patients at long term follow-up. CONCLUSIONS: Though the observational nature of this study limits us from drawing a more decisive conclusion, these results suggest that integrative treatment focused on CAM in cervical IDH inpatients may achieve favorable results in pain and functional improvement. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02257723. Registered October 2, 2014.
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Terapias Complementarias , Desplazamiento del Disco Intervertebral/terapia , Medicina Tradicional Coreana , Terapias Complementarias/efectos adversos , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Humanos , Pacientes Internos , Masculino , Persona de Mediana Edad , Dolor de Cuello/terapia , Estudios Prospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: Chronic temporomandibular disorder (TMD) is known to have strong correlations with psychological factors and to display gender disparity. However, while chronic TMD is known to affect quality of life, large-scale studies investigating the influence on quality of life by gender are scarce. METHODS: This cross-sectional study assessed the data of 17,198 participants aged ≥19 years who completed chronic TMD and EuroQol-5 Dimension sections in the 4th Korean National Health and Nutrition Examination Survey (2007-2009). We adjusted for covariates (health behavior, sociodemographic factors) in regression analysis for complex sampling design to calculate regression coefficients and 95% CIs for gender difference in the association between chronic TMD and quality of life. We also evaluated which covariates of somatic health, mental health, health behavior, and sociodemographic factors weakened the relationship between TMD and EQ-5D. RESULTS: Prevalence of chronic TMD was 1.6% (men 1.3%, women 1.8%), and chronic TMD persisted to negatively impact quality of life even after adjusting for confounding variables. Low sociodemographic factors and health behavior had a negative effect on quality of life. Somatic health and mental health were most affected by chronic TMD. As for quality of life, women were affected to a greater extent than men by TMD. Women were more affected by osteoarthritis and general mental health (stress, depressive symptoms, and thoughts of suicide), and men by employment. CONCLUSIONS: These results imply that chronic diseases and psychological factors are important in chronic TMD, and that there may be physiological and pathological gender differences in TMD.
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Calidad de Vida , Trastornos de la Articulación Temporomandibular/epidemiología , Adulto , Enfermedad Crónica , Estudios Transversales , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , República de Corea/epidemiología , Factores de Riesgo , Factores Sexuales , Factores Socioeconómicos , Adulto JovenRESUMEN
BACKGROUND: Patients seek Korean Medicine (KM) treatment for a broad range of complaints in Korea, but predominantly for musculoskeletal disorders. We investigated lumbar Intervertebral Disc Displacement (IDD) practice patterns of Korean Medicine doctors (KMDs) within a hospital/clinic network specializing in KM treatment of spinal disorders through survey of diagnosis and treatment methods. METHODS: Questionnaires on clinical practice patterns of KM treatment for lumbar IDD were distributed to 149 KMDs on January 25th, 2015. The questionnaire included items on sociodemographic characteristics, clinical practice patterns, and preferred method of lumbar IDD diagnosis and treatment. KMDs were asked to grade each treatment method for absolute and relative importance in treatment and prognosis, and safety. RESULTS: A total 79.19 % KMDs (n = 118/149) completed the survey, and results showed that integrative care mainly consisting of acupuncture, herbal medicine, Chuna manipulation, and pharmacopuncture was administered to IDD patients. The participant KMDs largely relied on radiological findings (MRI and X-ray) for diagnosis. 'Eight principle pattern identification', 'Qi and Blood syndrome differentiation' and 'Meridian system syndrome differentiation' theories were generally used for KM syndrome differentiation. The most frequently prescribed herbal medication was Chungpa-jun, and most commonly used Chuna technique was 'sidelying lumbar extension displacement treatment'. IDD patients received 1.9 ± 0.3 treatment sessions/week, and KMDs estimated that an average 9.6 ± 3.5 weeks were needed for 80 % pain relief. CONCLUSIONS: This is the first study to investigate expert opinion on KM treatment of IDD. Further randomized controlled trials and clinical guidelines based on clinical practice patterns of KM are called for.
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Medicina Integrativa , Desplazamiento del Disco Intervertebral/terapia , Dolor de la Región Lumbar/terapia , Vértebras Lumbares , Medicina Tradicional Coreana , Terapia por Acupuntura , Adulto , Encuestas de Atención de la Salud , Humanos , Dolor de la Región Lumbar/etiología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina , Pronóstico , República de CoreaRESUMEN
BACKGROUND: Lumbar disc herniation is a major cause of sciatica and low back pain and imposes a heavy burden on both individual and society. While use of pharmacopuncture, a combined form of acupuncture and herbal medicine, for lumbar disc herniation is widespread in Korea and China, there is a paucity of research. METHODS/DESIGN: This study is the protocol for a three-armed, randomized, patient, physician, and assessor-blinded controlled pilot study. Sixty patients with severe non-acute sciatic pain diagnosed with lumbar disc herniation (NRS ≥ 5, onset between 4 weeks and 6 months) will be recruited and randomized 20 each to the Shinbaro pharmacopuncture (pharmacopuncture with acupuncture), acupuncture, and usual care groups, respectively. The 2 acupuncture groups will receive 2 sessions/week of acupuncture alone or with pharmacopuncture for 4 weeks (total 8 sessions), and the usual care group will receive conventional medication 2-3 times/day and physical therapy 2 sessions/week over 4 weeks (total 8 sessions). The initial acupuncture physician will administer acupuncture at 5 acupoints (GB30, BL40, BL25, BL23, GB34) in the 2 acupuncture groups, and mark an additional acupoint. A second acupuncture physician will administer pharmacopuncture to the marked acupoint in the pharmacopuncture group, and acupuncture in the acupuncture group during acupuncture needle retention. The second physician will administer acupuncture and pharmacopuncture in a similar manner in terms of advice and manual stimulation to maintain patient-blinding, treat the patient out of view of the initial physician, remove the additional acupuncture needle immediately, and cover the area with adhesive bandage to maintain physician-blinding. The primary endpoint will be at 5 weeks post-randomization, and the primary outcome will be Visual Analog Scale (VAS) of sciatic pain. Secondary outcomes will be VAS of low back pain, Numeric Rating Scale (NRS) of low back pain and sciatic pain, ODI, SF-36, EQ-5D, and PGIC. Post-treatment evaluations will take place 5, 7, 9, and 12 weeks after randomization. DISCUSSION: This trial will evaluate the comparative clinical effectiveness of pharmacopuncture for severe non-acute sciatic pain patients diagnosed with lumbar disc herniation with usual care of conventional medicine and that of Korean medicine (acupuncture), monitor its safety, and serve as basis for a large-scale, multicenter trial. TRIAL REGISTRATION: ClinicalTrials.gov NCT02384928 , registered 27 February 2015.
Asunto(s)
Terapia por Acupuntura/métodos , Analgésicos/administración & dosificación , Desplazamiento del Disco Intervertebral/terapia , Disco Intervertebral/fisiopatología , Vértebras Lumbares/fisiopatología , Extractos Vegetales/administración & dosificación , Ciática/terapia , Terapia por Acupuntura/efectos adversos , Adulto , Analgésicos/efectos adversos , Protocolos Clínicos , Terapia Combinada , Femenino , Humanos , Inyecciones , Desplazamiento del Disco Intervertebral/diagnóstico , Desplazamiento del Disco Intervertebral/fisiopatología , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Extractos Vegetales/efectos adversos , República de Corea , Proyectos de Investigación , Ciática/diagnóstico , Ciática/fisiopatología , Factores de Tiempo , Resultado del TratamientoRESUMEN
The incidence of functional intussusception is extremely rare in adults. A 23-year-old woman, previously diagnosed with type 1 diabetes mellitus (DM), complained of colicky abdominal pain associated with vomiting of 1-day duration. Currant jelly stool was observed. Irrespective of hydration and intravenous insulin injection under the diagnosis of diabetic ketoacidosis (DKA), her abdominal pain and laboratory parameters did not improve. Abdominal computerized tomography (CT) revealed a jejunojejunal intussusception. We maintained large-volume fluid administration, and her abdominal pain began to subside. The stool culture was positive for Vibrio parahaemolyticus. We confirm the intussusception that was resolved by supportive management without surgical intervention in a patient with gastroenteritis and diabetic ketoacidosis.
Asunto(s)
Cetoacidosis Diabética/complicaciones , Gastroenteritis/complicaciones , Intususcepción/etiología , Enfermedades del Yeyuno/etiología , Vibriosis/complicaciones , Dolor Abdominal/diagnóstico , Dolor Abdominal/etiología , Adulto , Terapia Combinada , Cetoacidosis Diabética/diagnóstico , Cetoacidosis Diabética/terapia , Femenino , Estudios de Seguimiento , Gastroenteritis/microbiología , Gastroenteritis/terapia , Humanos , Intususcepción/diagnóstico , Intususcepción/terapia , Enfermedades del Yeyuno/diagnóstico , Enfermedades del Yeyuno/terapia , Medición de Riesgo , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Vibriosis/diagnóstico , Vibriosis/terapia , Vibrio parahaemolyticus/aislamiento & purificaciónRESUMEN
Hyperglycemic hyperosmolar state (HHS) is an acute complication mostly occurring in elderly type 2 diabetes mellitus (DM). Thyrotoxicosis causes dramatic increase of glycogen degradation and/or gluconeogenesis and enhances breakdown of triglycerides. Thus, in general, it augments glucose intolerance in diabetic patients. A 23-yr-old female patient with Graves' disease and type 2 DM, complying with methimazole and insulin injection, had symptoms of nausea, polyuria and generalized weakness. Her serum glucose and osmolarity were 32.7 mM/L, and 321 mosm/kg, respectively. Thyroid function tests revealed that she had more aggravated hyperthyroid status; 0.01 mU/L TSH and 2.78 pM/L free T3 (reference range, 0.17-4.05, 0.31-0.62, respectively) than when she was discharged two weeks before (0.12 mU/L TSH and 1.41 pM/L free T3). Being diagnosed as HHS and refractory Graves' hyperthyroidism, she was treated successfully with intravenous fluids, insulin and high doses of methimazole (90 mg daily). Here, we described the case of a woman with Graves' disease and type 2 DM developing to HHS.