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Clinical Pediatrics
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Severe Hypernatremia and Hyperosmolality Exacerbated by an Herbal Preparation in a Patient With Diabetic Ketoacidosis

Samar K. Bhowmick, MD, FACE

Division of Pediatric Endocrinology, University of South Alabama Medical Center, Mobile, Alabama, sbhowmick{at}usouthal.edu

Olivette T. Hundley, MD

Division of Pediatric Endocrinology, University of South Alabama Medical Center, Mobile, Alabama

Kenneth R. Rettig, MD

Division of Pediatric Endocrinology, University of South Alabama Medical Center, Mobile, Alabama

This article reports a case of severe reversible hypernatremia exacerbated by an herbal agent "goldenseal" (Hydrastis canadensis) in an 11-year-old girl with new onset type I diabetes mellitus presented with diabetic ketoacidosis. A literature review is presented and possible mechanism of hypernatremia caused by this herbal preparation is discussed.

Key Words: diabetic ketoacidosis • hypernatremia • hyperosmolar hyperglycemic state • glutamic acid decarboxylase • islet cell antibody

References

  • Wolfsdorf J., Glaser N., Sperling MA, American Diabetes Association. Diabetic ketoacidosis in infants, children, and adolescents: a consensus statement from the American Diabetes Association. Diabetes Care. 2006;29:1150-1159.[Free Full Text]
  • Frier BM, Steer CR, Baird JD, Bloomfield S. Misleading plasma electrolytes in diabetic children with severe hyperlipidemia. Arch Dis Child. 1980;55:771-775.[Abstract/Free Full Text]
  • Bhowmick SK, Levens KL, Rettig KR Hyperosmolar hyperglycemic crisis: an acute threatening event in children and adolescents with type 2 diabetes mellitus. Endocr Pract. 2005;11:23-29.[Medline] [Order article via Infotrieve]
  • McDonnell CM, Pedreira CC, Vadamalayan B., Cameron FJ, Werther GA Diabetic ketoacidosis, hyperosmolarity, and hypernatremia: are high-carbohydrate drinks worsening initial presentation? Pediatr Diabetes. 2005;6:90-94.
  • Murry MT, Pizzoreno JE Hydrastis canadensis (goldenseal) and other berberine containing botanicals. In: Pizzoreno JE, Murrary MT, eds. Textbook of Natural Medicine. 2nd ed. Edinburgh, UK: Churchill Livingstone; 1999:775-781.
  • Hobbs C. Goldenseal in early American medical botany. Pharm Hist. 1990;32:79-82.[Medline] [Order article via Infotrieve]
  • Scazzocchio F., Cometa MF, Palmery M. Antimicrobial activity of Hydrastis canadensis extract and its major isolated alkaloids. Fitoterapia. 1998;69:58-59.
  • Schwab IR, Chavis PS, Husted R., et al. Complementary therapy assessment: nutritional supplements: perioperative implications of eye surgery. American Academy of Ophthalmology Complementary Therapy Task Force. 10 November 2003:9-10.
  • Leak JA Potential hazards of perioperative herb and supplement use. ASA Refresher Courses Anesthesiol. 2003; 31:117-126.[CrossRef]
  • Chan RH, Kwan K., Abramson BL Complementary and alternate medicine use in patients with cardiovascular disease: a breakdown in patient's physician communication. Program and Abstracts of the American Heart Association Scientific Seminar, 15 November 2005, Dallas, TX. Abstract 2520.

This version was published on December 1, 2007

Clinical Pediatrics, Vol. 46, No. 9, 831-834 (2007)
DOI: 10.1177/0009922807303042
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This Article
Right arrow Abstract Freely available
Right arrow Free Full Text (Free PDF) Free
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Saved Citations
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Request Reprints
Right arrow Add to My Marked Citations
Citing Articles
Right arrow Citing Articles via Google Scholar
Right arrow Citing Articles via Scopus
Google Scholar
Right arrow Articles by Bhowmick, S. K.
Right arrow Articles by Rettig, K. R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Bhowmick, S. K.
Right arrow Articles by Rettig, K. R.
Social Bookmarking
Add to CiteULike   Add to Complore   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?