J Korean Med Sci.  2011 Mar;26(3):447-449. 10.3346/jkms.2011.26.3.447.

Hyperglycemic Hyperosmolar Syndrome Caused by Steroid Therapy in a Patient with Lupus Nephritis

• Kang SH
• Lee JY
• Park HS
• Sun IO
• Choi SR
• Chung BH
• Choi BS
• Yang CW
• Kim YS
• Park CW

• KMID: 2157886
• DOI: http://doi.org/10.3346/jkms.2011.26.3.447

Abstract

A 51-yr-old female was referred to our outpatient clinic for the evaluation of generalized edema. She had been diagnosed with idiopathic thrombocytopenic purpura (ITP). She had taken no medicine. Except for the ITP, she had no history of systemic disease. She was diagnosed with systemic lupus erythematosus. Immunosuppressions consisting of high-dose steroid were started. When preparing the patient for discharge, a generalized myoclonic seizure occurred at the 47th day of admission. At that time, the laboratory and neurology studies showed hyperglycemic hyperosmolar syndrome. Brain MRI and EEG showed brain atrophy without other lesion. The seizure stopped after the blood sugar and serum osmolarity declined below the upper normal limit. The patient became asymptomatic and she was discharged 10 weeks after admission under maintenance therapy with prednisolone, insulin glargine and nateglinide. The patient remained asymptomatic under maintenance therapy with deflazacort and without insulin or medication for blood sugar control.

Keyword

Hyperglycemic Hyperosmolar Syndrome; Lupus Nephritis; Steroids; Seizures

MeSH Terms

Edema
Epilepsies, Myoclonic/complications/drug therapy
Female
Humans
Hyperglycemia/*chemically induced
Immunosuppression
Insulin/therapeutic use
Lupus Nephritis/*complications/drug therapy
Middle Aged
Prednisolone/administration & dosage/*adverse effects/therapeutic use
Purpura, Thrombocytopenic, Idiopathic/complications/*drug therapy

Figure

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  Fig. 1 Course of platelet count and creatinine levels according to treatments. HD, hospital day; MPD, methylprednisolone; PD, prednisolone.

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  Fig. 2 Changes of hemoglobin A1c and osmolarity according to treatment. ADM, admission; HD, hospital day; DC, discharge.

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