Here is a concise summary of the text:
**Case Study:** CJ, a 46-year-old man, presents to the emergency room with severe symptoms.
**Background:**
* Traumatic life events led to depression, poor diet, and class 3 obesity (gaining 250+ pounds in 4 years)
* Neglected personal hygiene, including not brushing his teeth for 40 days, leading to an infected tooth
**Medical Crisis:**
* Developed hyperglycemic crisis (blood glucose level: 800 mg/dL, 10x normal)
* Symptoms: excessive thirst, polyuria (frequent urination), glucosuria (sugar in urine), and eventually, coma
* Diagnosed with type 2 diabetes, with the infected tooth as a precipitating factor
**Physiological Consequences:**
* Hyperosmolar effect: glucose drew water out of cells, leading to dehydration, kidney injury, and electrolyte imbalances
* Acute kidney injury, risking cardiac arrhythmias and sudden death
**Treatment and Recovery:**
* Antibiotics for the infection, removal of the abscessed tooth
* Rehydration (up to 20 liters of water over 48 hours) and insulin administration
* Full recovery with continued monitoring, counseling, and social support
Here are the key facts extracted from the text, numbered and in short sentences, without opinions:
**Patient Information**
1. CJ is a 46-year-old man.
2. CJ weighed over 400 pounds at admission.
3. CJ's estimated blood volume was about 9 liters.
**Medical History**
4. CJ lost his 5-year-old son in a sudden freak accident 5 years ago.
5. CJ's wife left him after the accident.
6. CJ's mother passed away about 2 months before his hospital admission.
**Symptoms and Diagnosis**
7. CJ experienced excessive thirst, abdominal discomfort, and shortness of breath.
8. CJ had a pounding toothache and was lethargic.
9. CJ's blood glucose level was 800 mg/dL, over 10 times the normal level.
10. CJ was diagnosed with hyperglycemic crisis and hyperosmolar hyperglycemic state.
11. CJ had glucosuria (sugar in his urine), polydipsia (unquenchable thirst), and polyuria (frequent urination).
**Physiological Consequences**
12. CJ's high blood glucose level caused water to flow out of his cells, leading to dehydration.
13. His kidneys were overloaded, leading to acute kidney injury.
14. CJ's body became massively dehydrated, decreasing perfusion to his kidneys.
**Treatment**
15. CJ was treated with antibiotics for his infected tooth, which was later removed.
16. CJ received rehydration efforts, with up to 20 liters of water infused into his veins over 48 hours.
17. Insulin was administered intravenously to restore insulin sensitivity.
**General Medical Information**
18. Ancient Egyptian physicians (1500 BC) and Ancient Chinese medical texts described conditions related to high sugar levels in urine.
19. The term "diabetic coma" was first described in Western literature in 1828 by August von Stosch.
20. Insulin was first extracted from cows in 1921 by Frederick Banting.
21. Genetically engineered human insulin was developed after 1980 using E. coli bacteria.