Wide Spread Arterial and Venous Thrombosis in a Case of Hyperglycemic Hyperosmolar State (HHS)

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. Characteristics Clinical Parameters Normal Range Age 50 years Gender female BMI 31.1 Kg/m2 Heart rate 126 beats/min. Blood pressure 93/40 mm Hg. Temperature 38 ̊C 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 275-295mOsm/Kg Sodium 132 mmol/L 135-145 mmo/L Potassium 6.1 mmol/L 3.5-5.5mmol/L Urea 18 mmol/L 2.5-7.1 mmol/L Creatinine 312 μmol/L 50-98 μmol/L Leucocytes 23X109/L 4-10X109/L Platelets 425 x103 150-400x103 Serum Lipase 1400 IU/L 13-60 IU/L Table 1: Characteristics of the patient. Citation: Ganaw A, Shaikh N, Marcus AE, Soekarman D (2018) Wide Spread Arterial and Venous Thrombosis in a Case of Hyperglycemic Hyperosmolar State (HHS) 5: 027.