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

Figures & data

Figure 1 Histologic findings of acute rejection after liver transplantation. The histologic characteristics indicated acute injection, including normal structure of hepatic lobules, fibrous proliferation of interlobular portal area, small bile-duct hyperplasia, visible lymphocyte infiltration around the small bile-duct wall, liver cell mild edema with cholestasis, and point necrosis.

Table 1 Liver function in different periods

Liver function	On admission	End of first MP therapy	Out of hospital	Reference value
AST (U/L)	163	153	40	1–37
ALT (U/L)	114	266	55	1–40
TBIL (mmol/L)	105.9	142	28.8	3–22

Abbreviations: MP, methylprednisolone; ALT, alanine aminotransferase; AST, aspartate aminotransferase; TBIL, total bilirubin.

Table 2 Laboratory tests of HNKHC pre- and posttreatment

Laboratory tests	Prior treatment	Posttreatment	Reference value
Serum glucose (mmol/L)	33	7	2.9–6.0
Potassium (mmol/L)	4.43	4.6	3.5–5.3
Sodium (mmol/L)	146	140	135–145
Chloride (mmol/L)	115	100	96–110
Creatinine (μmol/L)	109	105	53–115
Urea nitrogen (mmol/L)	14.5	8.5	2.9–8.6
Osmotic pressure (mOsm/L)	339	290	275–295
Urine sugar	Positive (++++)	Negative
Urine acetone bodies	Negative	Negative
Arterial blood gas
PH	7.35	7.4	7.35–7.45
HCO3 (mmol/L)	21	23	22–27

Abbreviation: HNKHC, hyperosmolar nonketotic hyperglycemic coma.