Case history
Case history #1
A 56-year-old woman with no prior documented history of diabetes is admitted to hospital for shortness of breath, fever, and a productive cough. The patient's vital signs are as follows: temperature 38.5°C (101.4°F); blood pressure 90/60 mmHg; pulse 110 beats per minute (bpm); respiratory rate 22 breaths per minute; and O₂ saturation 89% on ambient air. Chest x-ray obtained in the emergency department reveals a right lower lobe consolidation. Intravenous hydration and appropriate antibiotics for empirical treatment of lobar pneumonia are initiated. Her admission metabolic panel reveals a glucose level of 14.0 mmol/L (252 mg/dL).
Case history #2
A 55-year-old man presents to the emergency department with a 1-day history of intermittent chest discomfort. It is characterised as sharp and radiating down his left arm. He is obese but has no notable abnormalities on examination. An ST-elevation myocardial infarction is diagnosed, and he is taken to the catheterisation lab, where he undergoes successful percutaneous coronary intervention. Post-procedure he is admitted to the cardiac care unit for further care. His laboratory results are notable for a random glucose of 11.2 mmol/L (201 mg/dL) on admission. Two days later, fasting blood glucose is 6.4 mmol/L (115 mg/dL), and HbA1c is 43 mmol/mol (6.2%).
Other presentations
Inpatient hyperglycaemia presents with a wide variety of features and history. Patients may have a known history of diabetes mellitus preceding admission; a diagnosis of diabetes mellitus subsequently established when a presumed inciting factor is no longer present though hyperglycaemia still persists; or transient hyperglycaemia, related to, for example, corticosteroids.
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