[Clinical features of hypernatremic hyperosmolar delirium following open heart surgery]

Five cases of hypernatremic hyperosmolar delirium after open heart surgery were reviewed. Minimum serum osmolarity at the time of developing delirium in these cases was 336 mOsm/l. Blood glucose level did not reached to the levels of the typical criteria of hyperosmolar hyperglycemic nonketotic diabetic coma in all cases. The authors have shown that it was difficult to recognize this unique disorder in early postoperative stage. Because of its non-specific symptoms and the postoperative courses which required the patients' cares with much more dry side in water balance. In order to treat the patients with hypernatremic hyperosmolar delirium, the correction of serum osmolarity should be done very slowly, because water intoxication should be prevented. In all five cases in this paper were recovered from delirium as the time when serum natrium level and serum osmolarity were restored to the normal state. We concluded that in order to get a good prognosis of this characteristic disorder, we have shown early recognition of serum hypernatremia and hyperosmolarity state and consequently adequate treatment mentioned above are primarily important.