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

Authors Zhou J, Ju W, Yuan X, Zhu X, Wang D, He X

Received 16 June 2014

Accepted for publication 2 September 2014

Published 22 December 2014 Volume 2015:7 Pages 23—26

DOI https://doi.org/10.2147/TRRM.S69516

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Professor Qing Yi


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

Organ Transplant Center, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China

*These authors contributed equally to this work

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.

Keywords: liver transplantation, complications, hyperosmolar nonketotic hyperglycemic coma, methylprednisolone pulse therapy, principle of treatment


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