2011, Number 3
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ABSTRACTWe report the case of a 82 year-old woman with hyperosmolar hyperglycemic state (HHS) associated with hypernatremia, who was treated using 0.2 % sodium chloride in 5 % dextrose in water which resulted in the amelioration of the neurological symptoms in a short period of time, followed the decrease in serum glucose and the serum sodium, consequently the serum osmolality. We discuss the advantages and usefulness of 0.2 % sodium chloride in 5 % dextrose in water in this syndrome and emphasize its importance in the treatment. We reviewed the literature on HHS and we assume that this case reported was treated with hypotomic solution without subsequent neurological damage.
Kugler JP, Hustead T. Hyponatremia and hypernatremia in the elderly. Am Fam Physician 2000;61(12):3623-3630.
MacIsaac RJ, Lee LY, McNeil KJ, Tsalamandris C, Jerums G. Influence of age on the presentation and outcome of acidotic and hyperosmolar diabetic emergencies. Intern Med J 2002;32(8):379-385.
3 Chassagne P, Druesne L, Capet C, Ménard JF, Bercoff E. Clinical presentation of hypernatremia in elderly patients: a case control study. J Am Geriatr Soc 2006;54 (8);1125-1130.
Lorber D. Nonketotic hypertonicity in diabetes mellitus. Med Clin North Am 1995;79(1):39-52.
Kitabchi AE, Umpierrez GE, Murphy MB, Barrett EJ, Kreisberg RA, Malone JI, et al; American Diabetes Association. Hyperglycemic crises in diabetes. Diabetes Care 2004;27(Supl1):S94-102. Available at http://care. diabetesjournals.org/content/27/suppl_1/s94.long
Tanaka S, Kobayashi T, Kawanami D, Hori A, Okubo M, Nakanishi K, et al. Paradoxical glucose infusion for hypernatremia in diabetic hyperglycaemic hyperosmolar syndrome. J Intern Med 2000;248(2):166-168.
Worthley LI. Hyperosmolar coma treated with intravenous sterile water. A study of three cases. Arch Intern Med 1986;146(5):945-947.
Feig PU. Hypernatremia and hypertonic syndromes. Med Clin North Am 1981;65(2):271-290.
Magee MF, Bhatt BA. Management of decompensated diabetes. diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome. Crit Care Clin 2001;17(1):75-106.
Gullans SR, Verbalis JG. Control of brain volume during hyperosmolar and hypoosmolar conditions. Annu Rev Med 1993;44:289-301.
Adrogué HJ, Madías NE. Hypernatremia. N Engl J Med 2000;342(20):1493-1499.
Liamis G, Kalogirou M, Saugos V, Elisaf M. Therapeutic approach in patients with dysnatraemias. Nephrol Dial Transplant 2006;21(6):1564-1569. Available at http:// ndt.oxfordjournals.org/content/21/6/1564.long
Stoner GD. Hyperosmolar hyperglycemic state. Am Fam Physician 2005;71(9):1723-1730. Available at http:// www.aafp.org/afp/2005/0501/p1723.html
Katz MA. Hyperglycemia induced hyponatremia-calculation of expected serum sodium depression. N Engl J Med 1973; 289(16):843-844.
Oh MS, Carroll HJ. Disorders of sodium metabolism: hypernatremia and hyponatremia. Crit Care Med 1992;20(1):94- 103.