Hyperosmolar Therapy for Diabetic Hyperosmolar Ketoacidosis

Heldeweg, Micah LA and Drossaers, Joris R and Berend, Kenrick (2022) Hyperosmolar Therapy for Diabetic Hyperosmolar Ketoacidosis. European Journal of Case Reports in Internal Medicine, 9 (1). pp. 1-4. ISSN 2284-2594

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Hyperglycaemic hyperosmolar state (HHS) and diabetic ketoacidosis (DKA) features can occur simultaneously in 27% of diabetic emergencies and have a two-fold increased risk of death. Despite the high prevalence of this combination, recommended treatments from leading guidelines may not be compatible with the clinical picture. A 36-year-old man presented with explicit concurrent HHS and DKA. The recommended treatment with simultaneous insulin and volume repletion was followed but resulted in an excessively rapid decline in serum osmolarity. Hyperosmolar therapy (NaCl 3%) was initiated to mitigate the risk of potentially fatal cerebral osmotic shifts.The concomitant presence of DKA and HHS leads to a treatment dilemma with a high risk of excessive osmolarity shifts. More evidence is needed, but it is reasonable to initiate tailored treatment to avoid osmolarity reduction rates exceeding the hypernatraemia-based limit of 24 mOsm/l/day. Hyperosmolar therapy can be considered but requires frequent monitoring of electrolytes and osmolarity.

Item Type: Article
Uncontrolled Keywords: Hyperosmolar hyperglycaemic state, diabetic ketoacidosis, osmolarity, cerebral oedema, case report
Subjects: 600 Tecnologia - Scienze applicate > 610 Medicina e salute (Classificare qui la tecnologia dei servizi medici)
Depositing User: Marina Spanti
Date Deposited: 15 Mar 2022 16:59
Last Modified: 15 Mar 2022 16:59
URI: http://eprints.bice.rm.cnr.it/id/eprint/21683

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