Asymptomatic, nonketotic, severe hyperglycemia with hyponatremia

Popli, Subhash; Leehey, David J.; Daugirdas, John T.; Bansal, Vinod; Ho, Dominic S.; Hano, Jessie E.; Ing, Todd S.

doi:10.1001/archinte.150.9.1962

Cited by 13 publications

(7 citation statements)

References 8 publications

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“…Some studies suggest altered sensorium determined by the levels of serum sodium, especially in non-ketotic hyperglycemia hyperosmolar syndrome [ 5 , 6 ].…”

Section: Discussionmentioning

confidence: 99%

A Case of Diabetic Ketoacidosis Presenting with Hypernatremia, Hyperosmolarity, and Altered Sensorium

Kumar

Nanavati

Melki

et al. 2018

Case Reports in Endocrinology

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Diabetic Ketoacidosis commonly presents with hyponatremia, but hypernatremia is a rare entity. We report a unique case of a 50-year-old woman admitted with altered sensorium with blood glucose 979 milligrams/deciliter, serum osmolarity 363 mOsm/kilograms, and serum sodium 144 milliequivalents/liter. Patient was given initial bolus of isotonic saline and continued on half isotonic saline for correction of hypernatremia along with insulin infusion therapy. Patient was successfully treated with intravenous fluids, insulin infusion, and the altered sensorium was resolved without any sequelae. This case illustrates a teaching point in the use of intravenous fluids for the treatment of Diabetic Ketoacidosis with hypernatremia.

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“…Some studies suggest altered sensorium determined by the levels of serum sodium, especially in non-ketotic hyperglycemia hyperosmolar syndrome [ 5 , 6 ].…”

Section: Discussionmentioning

confidence: 99%

A Case of Diabetic Ketoacidosis Presenting with Hypernatremia, Hyperosmolarity, and Altered Sensorium

Kumar

Nanavati

Melki

et al. 2018

Case Reports in Endocrinology

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“…The calculated value of tonicity assesses the severity of hypertonicity at presentation. Neurological manifestations from hypertonicity usually develop at tonicity values exceeding 320 mOsm/kg 11,12 . Tonicity decreases during treatment of dialysis‐associated hyperglycemia with insulin infusion 6,9 .…”

Section: Discussionmentioning

confidence: 99%

Extreme hyperglycemia with ketoacidosis and hyperkalemia in a patient on chronic hemodialysis

Gupta

Rohrscheib

Tzamaloukas

2008

Hemodialysis International

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A patient on hemodialysis for end-stage renal disease secondary to diabetic nephropathy was admitted in a coma with Kussmaul breathing and hypertension (232/124 mmHg). She had extreme hyperglycemia (1884 mg/dL), acidosis (total CO(2) 4 mmol/L), hyperkalemia (7.2 mmol/L) with electrocardiographic abnormalities, and hypertonicity (330.7 mOsm/kg). Initial treatment with insulin drip resulted in a decrease in serum potassium to 5.3 mmol/L, but no significant change in mental status or other laboratory parameters. Hemodialysis of 1.75 hours resulted in rapid decline in serum glucose and tonicity and rapid improvement of the acidosis, but no change in mental status, which began to improve slowly after the hemodialysis was stopped, but with ongoing treatment with continuous insulin infusion. The rate of decline in tonicity during hemodialysis (14.5 mOsm/kg/h) was high, raising concerns about neurological complications. In this case, extreme hyperglycemia with ketoacidosis, hyperkalemia, and coma developing in a hemodialysis patient responded to insulin infusion. Monitoring of the clinical status and the pertinent laboratory values is required to assess the need for other therapeutic measures including volume and potassium replacement and emergency dialysis. The indications for and risks of emergency dialysis in this setting are not clearly defined.

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“…Therefore, hypertonicity exclusively due to hyperglycemia is physiologically dampened in the Central Nervous System (CNS). On the other hand, hypertonicity due to hypernatremia has a greater impact on the CNS and it has been suggested that the P Na + is a better predictor of neurological impairment than the P G itself, since severely hyperglycemic patients can be fully asymptomatic in the absence of hypernatremia [ 35 ].…”

Section: Treatmentmentioning

confidence: 99%

Hyperglycemic Hyperosmolar State: A Pragmatic Approach to Properly Manage Sodium Derangements

Baldrighi

Sainaghi

Bellan

et al. 2018

CDR

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Introduction: Although hypovolemia remains the most relevant problem during acute de-compensated diabetes in its clinical manifestations (diabetic ketoacidosis, DKA, and hyperglycemic hy-perosmolar state, HHS), the electrolyte derangements caused by the global hydroelectrolytic imbalance usually complicate the clinical picture at presentation and may be worsened by the treatment itself.Aim: This review article is focused on the management of dysnatremias during hyperglycemic hyperos-molar state with the aim of providing clinicians a useful tool to early identify the sodium derangement in order to address properly its treatment.Discussion: The plasma sodium concentration is modified by most of the therapeutic measures common-ly required in such patients and the physician needs to consider these interactions when treating HHS. Moreover, an improper management of plasma sodium concentration (PNa+) and plasma osmolality dur-ing treatment has been associated with two rare potentially life-threatening complications (cerebral edema and osmotic demyelination syndrome). Identifying the correct composition of the fluids that need to be infused to restore volume losses is crucial to prevent complications.Conclusion: A quantitative approach based on the comparison between the measured PNa+ (PNa+M) and the PNa+ expected in the presence of an exclusive water shift (PNa+G) may provide more thorough infor-mation about the true hydroelectrolytic status of the patient and may therefore, guide the physician in the initial management of HHS. On the basis of data derived from our previous studies, we propose a 7-step algorithm to compute an accurate estimate of PNa

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Asymptomatic, nonketotic, severe hyperglycemia with hyponatremia

Cited by 13 publications

References 8 publications

A Case of Diabetic Ketoacidosis Presenting with Hypernatremia, Hyperosmolarity, and Altered Sensorium

A Case of Diabetic Ketoacidosis Presenting with Hypernatremia, Hyperosmolarity, and Altered Sensorium

Extreme hyperglycemia with ketoacidosis and hyperkalemia in a patient on chronic hemodialysis

Hyperglycemic Hyperosmolar State: A Pragmatic Approach to Properly Manage Sodium Derangements

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