Hyperosmolar Coma: Cellular Dehydration and the Serum Sodium Concentration
Authors: John T. Daugirdas
Journal: Annals of Internal Medicine (1989)

Editorials1 June 1989Hyperosmolar Coma: Cellular Dehydration and the Serum Sodium ConcentrationJohn T. Daugirdas, MD, Nouhad O. Kronfol, MD, Antonios H. Tzamaloukas, MD, Todd S. Ing, MDJohn T. Daugirdas, MD, Nouhad O. Kronfol, MD, Antonios H. Tzamaloukas, MD, Todd S. Ing, MDAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-110-11-855 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptNonketotic hyperosmolar coma is a syndrome found mostly in diabetic patients with marked hyperglycemia; the relative pathogenetic roles of hyperglycemia, hyperosmolality, and cellular (especially brain) dehydration in causing the comatose state have not been fully delineated (1-3). Examination of recent reports of dialysis patients with extreme hyperglycemia who were not comatose (4-6), and re-analysis of descriptions of nondialysis patients with nonketotic hyperosmolar coma (1) can help us better understand the proposed causes for hyperosmolar coma.Hyperglycemia has an important indirect pathogenetic role (1-3); in patients with adequate renal function, hyperglycemia initiates an osmotic diuresis (7) that continues until stopped by...References1. ArieffCarroll AH. Nonketotic hyperosmolar coma with hyperglycemia: clinical features, pathophysiology, renal function, acidbase balance, plasma-cerebrospinal fluid equilibria and the effects of therapy in 37 cases. Medicine (Baltimore). 1972;51:73-94. CrossrefMedlineGoogle Scholar2. ArieffGuisadoLazarowitz ARV. Pathophysiology of hyperosmolar states. In: Andreoli TE, Grantham JJ, Rector FC Jr, eds. Disturbances in Body Fluid Osmolality. Bethesda: American Physiological Society; 1977:227-50. Google Scholar3. 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Diabetes. 1966;15:714-22. CrossrefMedlineGoogle Scholar10. ArieffKleeman AC. Studies on mechanisms of cerebral edema in diabetic comas. Effects of hyperglycemia and rapid lowering of plasma glucose in normal rabbits. J Clin Invest. 1973;52:571-83. CrossrefMedlineGoogle Scholar11. FernandezMcGinnHoffman JJR. Cerebral edema from blood-brain glucose differences complicating peritoneal dialysis. Second membrane syndrome. NY State J Med. 1968;68:677-80. MedlineGoogle Scholar12. Lund-Andersen H. Transport of glucose from blood to brain. Physiol Rev. 1979;59:305-52. CrossrefMedlineGoogle Scholar13. KleemanDavsonLevin CHE. Urea transport in the central nervous system. Am J Physiol. 1962;203:739-47. CrossrefMedlineGoogle Scholar14. FeigMcCurdy PD. The hypertonic state. N Engl J Med. 1977;297:1144-54. CrossrefGoogle Scholar15. Katz M. Hyperglycemia-induced hyponatremia—calculation of expected serum sodium depression. N Engl J Med. 1973;289:843-4. CrossrefMedlineGoogle Scholar16. RoscoeHalperinRollestonGoldstein JMFM. Hyperglycemia-induced hyponatremia: metabolic considerations in calculation of serum sodium depression. Can Med Assoc J. 1975;12:452-3. Google Scholar17. RobinIngLancaster ATG. Hyperglycemia-induced hyponatremia: a fresh look. Clin Chem. 1979;25:496-7. CrossrefMedlineGoogle Scholar18. BoyerGillEpstein JGF. Hyperglycemia and hyperosmolality complicating peritoneal dialysis. Ann Intern Med. 1967;67:568-72. LinkGoogle Scholar19. DoromalCanter NJ. Hyperosmolar hyperglycemic nonketotic coma complicating intravenous hyperalimentation. Surg Gynecol Obstet. 1973;136:729-32. MedlineGoogle Scholar20. RosenbergBriefKinneyHerreraWilsonMoore SDJMRF. The syndrome of dehydration, coma and severe hyperglycemia without ketosis in patients convalescing from burns. N Engl J Med. 1965;272:931-8. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. 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