title: Iatrogenic nondiabetic hyperosmolar states.
abstract: Four cases of the iatrogenic nondiabetic hyperosmolar state are presented. The clinical presentation, biochemical findings and management are discussed. No hypertonic solution should be infused at a rate above the level of patient tolerance; irrigation of a hollow viscus with a hypertonic solution should be avoided, and salt should not be used as an emetic. Patients under stress are particularly prone to this condition, largely because of the high circulating cortisol levels. The use of corticosteroids, salt-containing solutions in excess of patient requirements, water depletion and intravenous nutrition in the absence of careful biochemical monitoring, are all factors which may precipitate the hyperosmolar state in the critically ill.
mesh_terms: D000137:Acid-Base Imbalance / Q000139:chemically induced; D000328:Adult; D000368:Aged; D001639:Bicarbonates / Q000506:poisoning; D002543:Cerebral Hemorrhage / Q000139:chemically induced; D002951:Citrates / Q000506:poisoning; D005260:Female; D005950:Glucose Solution, Hypertonic / Q000009:adverse effects; D006801:Humans; D006943:Hyperglycemia / Q000139:chemically induced*; D006944:Hyperglycemic Hyperosmolar Nonketotic Coma / Q000139:chemically induced; D006955:Hypernatremia / Q000139:chemically induced*; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D009994:Osmolar Concentration; D012462:Saline Solution, Hypertonic / Q000009:adverse effects; D012640:Seizures / Q000139:chemically induced; D017693:Sodium Bicarbonate
chemical_list: D001639:Bicarbonates; D002951:Citrates; D005950:Glucose Solution, Hypertonic; D012462:Saline Solution, Hypertonic; D017693:Sodium Bicarbonate