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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DKA-hyperosmolar coma is a readily diagnosed and easily treated, potentially catastrophic emergency that regularly occurs in both Type I and Type II diabetics. This review emphasized that diabetic ketoacidosis and hyperosmolar coma can, and very frequently do, occur concurrently, but it is the hyperosmolar state rather than the DKA that is the primary cause of coma and death in this condition. One must therefore vigorously treat the hyperosmolarity and resulting dehydration, especially when total calculated osmolarity exceeds 230 to 240 mOsm/L. ⋯ The diagnosis of this dangerous condition is relatively simple. The therapy, in most regards, is equally apparent. There are good data demonstrating that the prompt recognition of DKA-hyperosmolar coma and the simple institution of rapid rehydration have continued to reduce the mortality and complications of this potentially disastrous complication of diabetes mellitus.