Abstract
Introduction: Although hypovolemia remains the most relevant problem during acute decompensated diabetes in its clinical manifestations (diabetic ketoacidosis, DKA, and hyperglycemic hyperosmolar 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 hyperosmolar 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 commonly 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 during 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 information 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+ G.
Keywords: Hyperglycemic hyperosmolar state, hyponatremia, hypernatremia, cerebral edema, osmotic demyelination syndrome, fluid therapy.
Current Diabetes Reviews
Title:Hyperglycemic Hyperosmolar State: A Pragmatic Approach to Properly Manage Sodium Derangements
Volume: 14 Issue: 6
Author(s): Marco Baldrighi, Pier P. Sainaghi, Mattia Bellan, Ettore Bartoli and Luigi M. Castello*
Affiliation:
- Department of Translational Medicine, Universita del Piemonte Orientale, Novara,Italy
Keywords: Hyperglycemic hyperosmolar state, hyponatremia, hypernatremia, cerebral edema, osmotic demyelination syndrome, fluid therapy.
Abstract: Introduction: Although hypovolemia remains the most relevant problem during acute decompensated diabetes in its clinical manifestations (diabetic ketoacidosis, DKA, and hyperglycemic hyperosmolar 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 hyperosmolar 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 commonly 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 during 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 information 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+ G.
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Cite this article as:
Baldrighi Marco, Sainaghi P. Pier, Bellan Mattia, Bartoli Ettore and Castello M. Luigi *, Hyperglycemic Hyperosmolar State: A Pragmatic Approach to Properly Manage Sodium Derangements, Current Diabetes Reviews 2018; 14 (6) . https://dx.doi.org/10.2174/1573399814666180320091451
DOI https://dx.doi.org/10.2174/1573399814666180320091451 |
Print ISSN 1573-3998 |
Publisher Name Bentham Science Publisher |
Online ISSN 1875-6417 |
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