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Hyperosmolar Syndrome, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • Results from a relative insulin deficiency in the undiagnosed or untreated diabetic

  • Sustained hyperglycemia creates an osmotic diuresis and dehydration:

    • Extracellular space maintained ...

Diagnosis

Signs and Symptoms

History

  • Progression of signs and symptoms typically occur over days to weeks.

  • Polyuria/polydipsia/weight loss

  • Dizziness/weakness/fatigue

  • Blurred vision

  • Leg cramps

Physical Exam

  • De...

Treatment

Pre-Hospital

IV fluid resuscitation and initial stabilization 

Initial Stabilization/Therapy

ABCs: 
  • Secure airway in comatose patients.

  • Cardiac monitor and 18G IV

  • Naloxone, thiamine, and blood glu...

Follow-Up

Disposition

Admission Criteria

  • All but the mildest cases should be admitted to ICU:

    • Frequent serial labs for the 1st 24 hr

    • Rapid shifts in fluids and electrolytes and the potential for deteriora...

Pearls and Pitfalls

  • Failure to look for precipitating event or cause

  • Too rapid correction of glucose—may lead to hypotension

  • Continuing isotonic fluids after volume resuscitation—may lead to hypernatrem...

Additional Reading

  • Gaglia  JL, Wyckoff  J, Abrahamson  MJ. Acute hyperglycemic crisis in the elderly. Med Clin North Am.  2004;88:1063–1084.

  • Kitabchi  AE, Nyenwe  EA. Hyperglycemic crisis in diabe...

Codes

ICD9

  • 250.20 Diabetes with hyperosmolarity, type II or unspecified type, not stated as uncontrolled

  • 250.21 Diabetes with hyperosmolarity, type I [juvenile type], not stated as uncontrolled

  • 276.0 Hyp...

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