Endocrine Abstracts

Introduction

In Morocco, the Moorish bath is an important social ritual. All categories of society frequent it very regularly. The traditionnel bath can lead in the diabetic, by the means of acute decompensations, serious falls and burns, with heavy functional, social and psychological consequences. Through this observation, we report the risks associated with the Moorish bath, and we underline the value of educating diabetic patients and making them aware of the dangers of frequenting Moorish baths.

Case report

A 78-year-old patient, known to be diabetic for 20 years on oral antidiabetics, admitted to the intensive care unit for burns of the 2 lower limbs following a fall in a heated Moorish bath, in a context of consciousness disorders without idea on capillary glycemia, this incident had taken place during the afternoon without notion of taking the meal of the lunch. On clinical examination, the patient was conscious, hemodynamically and respiratory stable, apyretic, with a glycemic cycle of blood glucose levels around 3 g/l without ketosis. The skin surface area burned to the second degree was estimated at 18%. The patient received rehydration and appropriate daily dressings. He was put on a hyperglycemia correction regimen adapted to his cardiac and renal functions, then on a basic regimen of intensified insulin therapy. The course was marked by the installation of functional renal failure with necrosis of both feet. The patient died with suspicion of pulmonary embolism.

Discussion

Diabetic patients are usually complicated patients, due to the strong presence of systemic micro and macro vascular damage affecting multiple organs. Also, diabetes is well known to be associated with decreased healing ability. The Moorish bath can cause serious burns in these patients by several mechanisms: diabetic retinopathy, a source of reduced visual acuity that can be responsible for falls, neuropathy with skin insensitivity, as well as the significant effort deployed in the activities of the Moorish bath which could induce hypoglycemia.

Conclusion

In our society, the traditionnel bath is a synonym for hygiene and cleanliness, but it can be responsible for serious accidents in diabetic patients. Our observation elucidates the risks of the Moorish bath in these particularly vulnerable patients, hence the importance of prevention which involves educating diabetic patients or even banning the use of Moorish baths.