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Asymptomatic, nonketotic, severe hyperglycemia with hyponatremia
S Popli1, D J Leehey, J T Daugirdas
1Department of Medicine, Veterans Administration Hospital, Hines, Ill. 60141.
Archives of Internal Medicine
|September 1, 1990
Summary
Severe hyperglycemia with renal insufficiency can occur without symptoms in patients who are hyponatremic. Aggressive glucose lowering is not always necessary; monitor both sodium and glucose levels.
Area of Science:
- Nephrology
- Endocrinology
- Internal Medicine
Background:
- Severe hyperglycemia typically presents with symptoms and hypernatremia.
- Renal insufficiency can alter glucose and electrolyte metabolism.
Observation:
- Five patients presented with asymptomatic, nonketotic, severe hyperglycemia (45.8–92 mmol/L) and renal insufficiency.
- Unlike typical cases, these patients were hyponatremic, not hypernatremic.
Findings:
- Hyponatremia may prevent cerebral cellular dehydration, explaining the lack of symptoms.
- Aggressive treatment of hyperglycemia in this specific patient group is unnecessary.
Implications:
- Recognizing this distinct clinical entity is crucial for appropriate patient management.
- Monitoring both serum glucose and sodium levels is essential for identifying these patients.