Hamman Syndrome: Pneumomediastinum Combined with Hyperosmolar Hyperglycemic State

• Published in: The American journal of emergency medicine 2016-10, Vol.34 (10), p.2058.e1-2058.e2
• Main Authors: Hirayama, Ichiro, MD, Hiruma, Takahiro, MD, PhD, Ueda, Yoshihiro, MD, Doi, Kent, MD, PhD, Nakajima, Susumu, MD, PhD
• Format: Article
• Language: English
• Subjects: Aged; Blood pressure; Body temperature; Consciousness; Diabetes; Diabetes Complications - complications; Emergency; Emergency medical care; Hospitalization; Humans; Hyperglycemic Hyperosmolar Nonketotic Coma - complications; Hyperglycemic Hyperosmolar Nonketotic Coma - diagnosis; Male; Malnutrition; Mediastinal Emphysema - complications; Mediastinal Emphysema - diagnosis; Metabolism; Nutrition Disorders - complications; Nutritional status; Pathogenesis; Respiration; Syndrome
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2016.03.039

At admission, his respiratory rate was 33 breaths per minute, Spo2 was 95% (reservoir mask, 15L/min), blood pressure was 110/55mm Hg, pulse was 170 beats per minute and irregular, Glasgow Coma Scale was E3V3M5, and body temperature was 36.4°C. Based on the history of DM (hemoglobin A1c, 14.1%) and blood glucose of 577mg/dL and negative urine ketones owing to loss of appetite for the previous few days, the cause of impaired consciousness was considered HHS, and appropriate volume expansion, glycemic control, electrolyte correction, and systemic management were conducted. Similar to DKA, HHS causes Kussmaul breathing and poor nutritional status in many cases. [...]we considered that the Kussmaul breathing and malnutrition were involved in the development of pneumomediastinum.