Endocrinology and metabolism clinics of North America
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Endocrinol. Metab. Clin. North Am. · Jun 1993
ReviewPathogenesis and prevention of hyponatremic encephalopathy.
Hyponatremia is the most common in-hospital electrolyte abnormality, and it has recently become apparent that there are at least two hyponatremia-associated mechanisms that may induce brain injury. They are hyponatremic encephalopathy and brain damage associated with therapy. The diagnosis of hyponatremia is established easily at virtually no risk to the patient by evaluation of plasma electrolytes. Rapid and appropriate therapy with hypertonic NaCl is indicated prior to respiratory insufficiency to prevent brain damage.
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Lactic acidosis is the most common metabolic acidosis. At clinical presentation, several causes usually can be identified. ⋯ To date, no therapy specifically designed to lower arterial blood lactate levels has reduced mortality significantly. Prompt recognition and treatment of the underlying causes of lactic acidosis remain the cornerstone of treatment.
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AKA is an acute metabolic disorder that occurs in ethanol abusers who have usually had a recent binge and who, because of gastritis or another intercurrent illness, stop eating and drinking and often vomit repeatedly. This causes dehydration and ketoacidosis which, unlike in diabetics, is usually associated with little or no hyperglycemia or glucosuria. Despite the ketoacidosis, blood pH findings are variable, depending on the severity of coexisting metabolic alkalosis (owing to vomiting) and respiratory alkalosis (owing to pain or delirium tremens). ⋯ Insulin is usually not necessary, except in patients known or suspected to have diabetes. Because some patients have serious coexisting acute illnesses (which may even have precipitated the acute metabolic disorder), assiduous search for those and the appropriate treatment are essential. The prognosis for the acute metabolic disorder per se is excellent, that for coexisting illness depends on the illness, and that for the ethanol abuse is still often problematic.