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Published on: June 11, 2012
Management of the hyperosmolar hyperglycemic syndrome
1Mount Sinai School of Medicine of the City University of New York, New York City 10029, USA.
American Family Physician
|October 19, 1999
Summary
Severe hyperosmolar hyperglycemia, a complication of uncontrolled diabetes, requires prompt fluid resuscitation. Monitoring glucose decline ensures adequate rehydration and guides therapy for this critical condition.
Area of Science:
- Endocrinology
- Internal Medicine
- Critical Care Medicine
Background:
- Hyperglycemic hyperosmolarity exists on a spectrum with diabetic ketoacidosis.
- 50-75% of hospitalized patients with uncontrolled diabetes present with significant hyperosmolarity.
- Altered consciousness in uncontrolled diabetes is typically due to severe hyperosmolar hyperglycemia.
Purpose of the Study:
- To outline the clinical spectrum of severe hyperglycemic disorders.
- To emphasize the critical role of fluid resuscitation in managing hyperosmolar hyperglycemia.
- To highlight the importance of monitoring glucose decline and correcting electrolyte/vitamin deficits.
Main Methods:
- Prompt, rapid administration of crystalloid solutions with appropriate tonicity.
- Monitoring plasma glucose concentration decline (goal: 75-100 mg/dL per hour).
- Addressing total body deficits of potassium, phosphate, magnesium, and B-complex vitamins.
Main Results:
- Adequate rehydration is indicated by a significant decrease in plasma glucose concentration.
- Therapy aims to normalize glucose levels and correct associated deficits.
- Successful management prevents severe complications associated with hyperosmolar hyperglycemia.
Conclusions:
- Hyperosmolar hyperglycemia is a serious complication of uncontrolled diabetes requiring urgent intervention.
- Fluid resuscitation and careful monitoring are key to successful treatment.
- Comprehensive management includes correcting electrolyte and vitamin deficiencies.
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