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J R Soc Med. 1979 August; 72(8): 578–586.
PMCID: PMC1436911

Iatrogenic nondiabetic hyperosmolar states1


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.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
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  • Berger B, Evers W, Mueller CB. Mannitol-induced diuresis in hydropenic men. Surgery. 1968 Aug;64(2):381–386. [PubMed]
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  • Timperley WR, Preston FE, Ward JD. Cerebral intravascular coagulation in diabetic ketoacidosis. Lancet. 1974 May 18;1(7864):952–956. [PubMed]
  • WARD DJ. Fatal hypernatremia after a saline emetic. Br Med J. 1963 Aug 17;2(5354):432–432. [PMC free article] [PubMed]

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