Hyperosmolar nonketotic hyperglycemic coma induced by methylprednisolone pulse therapy for acute rejection after liver transplantation: A case report and review of the literature

Jian Zhou, Weiqiang Ju, Xiaopeng Yuan, Xiaofeng Zhu, Dongping Wang, Xiaoshun He

Research output: Contribution to journalArticle

Abstract

Hyperosmolar nonketotic hyperglycemic coma (HNKHC) is a serious, rare complication induced by methylprednisolone (MP) pulse therapy for acute rejection after orthotopic liver transplantation (OLT). Herein, we report an unusual case of a 58-year-old woman who experienced acute rejection at 30 months after OLT, only one case in which HNKHC resulted in MP pulse therapy for acute rejection in all 913 recipients in our center. The general morbidity of HNKHC was 1.09‰ in this study. HNKHC is characterized by rapid onset, rapid progression, and a lack of specific clinical manifestations. High-dose MP management was a clear risk factor. The principle of treatment included rapid rehydration, low-dose insulin infusion, and correcting disorders of electrolytes and acidosis. In conclusion, clinicians considering MP pulse therapy after OLT should be alert to the occurrence of HNKHC.

Original languageEnglish (US)
Pages (from-to)23-26
Number of pages4
JournalTransplant Research and Risk Management
Volume7
DOIs
StatePublished - Dec 22 2014

Keywords

  • Complications
  • Hyperosmolar nonketotic hyperglycemic coma
  • Liver transplantation
  • Methylprednisolone pulse therapy
  • Principle of treatment

ASJC Scopus subject areas

  • Statistics, Probability and Uncertainty
  • Transplantation

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