Journal article
Mesenteric venous thrombosis: A lethal complication of hyperglycemic crises
American journal of health-system pharmacy, v 78(2), pp 105-107
05 Jan 2021
PMID: 33119766
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Purpose. Although hyperglycemic crises can lead to a hypercoagulable state, few instances of associated mesenteric venous thrombosis (MVT) have been reported. Worsening abdominal pain in the context of shock requiring vasopressor support should prompt urgent further investigation.
Summary. A 44-year-old Hispanic male arrived at an emergency department with chief complaints of lethargy, polydipsia, and polyuria. His past medical history included type 2 diabetes, epilepsy, obesity, tobacco smoking, and noncompliance with his medications. On arrival the patient had a serum glucose concentration of >1,600 mg/dL, and hyperosmolar hyperglycemic syndrome (HHS) was diagnosed. The patient was admitted to the intensive care unit with respiratory failure and subsequently developed shock refractory to fluid resuscitation, necessitating vasopressor support. On hospital day 4, a computerized tomogram obtained for investigation of increasing abdominal tenderness revealed superior MVT and pneumatosis intestinalis. Despite an emergency laparotomy and enterectomy, the patient ultimately succumbed on hospital day 41 due to recurrent pneumonia complicated by acute respiratory distress syndrome and septic shock.
Conclusion. Shock that is refractory to aggressive fluid resuscitation, necessitating pressor support, in the setting of HHS or diabetic ketoacidosis should prompt investigation for the underlying source of shock. Other etiologies, including hypovolemic, cardiogenic, and obstructive shock, should be considered; however, infection is the leading trigger of hyperglycemic crises. Although rarely reported, MVT should be considered in the diagnostic algorithm in the absence of an identified infectious source. Prompt investigation should include use of diagnostic modalities such as computed tomography to assess for MVT.
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Details
- Title
- Mesenteric venous thrombosis: A lethal complication of hyperglycemic crises
- Creators
- Andrew Tsai - Somerset Medical CenterAmanda Teichman - Johnson UniversityChristopher A. Butts - Somerset Medical CenterJenny Y. Cai - Somerset Medical CenterGregory L. Peck - Rutgers, The State University of New JerseyChristopher D. Adams - Somerset Medical CenterJoseph S. Hanna - Somerset Medical Center
- Publication Details
- American journal of health-system pharmacy, v 78(2), pp 105-107
- Publisher
- Oxford Univ Press
- Number of pages
- 3
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Surgery
- Web of Science ID
- WOS:000609886800008
- Scopus ID
- 2-s2.0-85099428276
- Other Identifier
- 991021929442404721
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- Web of Science research areas
- Pharmacology & Pharmacy