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Archivos de Medicina de Urgencia de México

2012, Number 2

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Arch Med Urg Mex 2012; 4 (2)

The clinical course of patients with hyperosmolar state in the Emergency Service

Hernández-Pérez F, González CDC

Language: Spanish
References: 39
Page: 65-71
PDF size: 57.96 Kb.


ABSTRACT

The hyperosmolar state is more common in patients with DM of long duration; however, can also occur hyperosmolar state (HS) with blood glucose below 600 mg/dL, by raising the concentration of sodium and worse, a combination of both, who have a worse prognosis. Objectives: To study the clinical course of patients with hyperosmolar state and to know if it’s worse the outcome of patients with HS if it’s associated with elevation of serum sodium. Methods: We used a cross-sectional analytical study, patients over 18 year old were admitted to the Emergency Service, having been diagnosed with hyperosmolar state (osmolarity measurement greater than 320 mOsm/kg) to which they assessed the hydric state, neurological status as well as serum sodium, glucose and BUN. Results: We studied 70 patients, 37 (52.9%) men and 33 women, mean age were 53.74 years. Sodium income was 132.48 ± 10.6 mEq/L, glucose of 788.59 ± 221.55 mg/dL, BUN of 40.26 ± 26.36. Two thirds (66.2%) were admitted with hyperglycemic hyperosmolar state. Sodium corrected average was 143.81 ± 10.77, the average effective osmolarity was 331.67 ± 27.96 and calculate osmolarity was 344.29 ± 30.85 with a anion gap of 26.71 ± 15.73. Only eight patients died, all associated with a serious disease, we was found that the higher sodium and osmolarity calculated was higher on deseased patients (p = 0.05 and 0.02 respectively), also a higher sodium than 150 mEq/L was a factor a poor prognosis (9.8 95%, CI 1.99-48.43). Conclusions: Hypernatremia is a poor prognostic factor in patients with hyperosmolar state, mortality was 11.4%. The hypernatremic hyperosmolar state should be considered as a worse case than hyperglycemic hyperosmolar state.


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