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Q J Med 2002; 95: 113-124
© 2002 Association of Physicians

Masterclasses in medicine

Severe degree of hyperglycaemia: insights from integrative physiology

M.R. Davids1, Y. Edoute2, S. Stock3 and M.L. Halperin4,

1 From the Nephrology Unit and Department of Internal Medicine, University of Stellenbosch, Cape Town, South Africa, 2 Department of Internal Medicine C, Rambam Medical Center, Haifa, Israel, 3 Division of Endocrinology, Hospital for Sick Children, Toronto, Canada, and 4 Division of Nephrology, St Michael's Hospital, University of Toronto, Toronto, Canada

Summary

We illustrate how the application of principles of integrative physiology at the bedside can reveal novel insights that have been largely overlooked to this day. In this didactic exercise, modern-day physicians seek an imaginary medical consultation with Professor Sir Hans Krebs because of an unusual finding in his area of expertise: a very severe degree of hyperglycaemia. Although Professor Krebs is restricted to data prior to World War II, this does not prevent him from making novel discoveries. First, he illustrates how an occult factor, rapid absorption of glucose from the intestinal tract, was a critical feature in explaining the basis of the severe degree of hyperglycaemia without obvious ketoacidosis in a 16-year-old patient with type 1 diabetes mellitus in poor control. Second, by examining simple principles of renal and gastrointestinal physiology in a quantitative fashion, Professor Krebs speculates as to how cerebral oedema might occur before therapy in a patient with a severe degree of hyperglycaemia. We hope that readers and educators will appreciate the value of applying principles of integrative physiology in a quantitative fashion at the bedside.

Notes

Address correspondence to Dr M.L. Halperin, Professor of Medicine, University of Toronto, St Michael's Hospital Annex, Lab #1, Research Wing, 38 Shuter Street, Toronto, Ontario M5B 1A6, Canada. e-mail: mitchell.halperin{at}utoronto.ca


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