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

Iatrogenic nondiabetic hyperosmolar states1

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.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Barer J, Hill LL, Hill RM, Martinez WM. Fatal poisoning from salt used as an emetic. Am J Dis Child. 1973 Jun;125(6):889–890. [PubMed]
  • Berger B, Evers W, Mueller CB. Mannitol-induced diuresis in hydropenic men. Surgery. 1968 Aug;64(2):381–386. [PubMed]
  • Cashman TM, Shirkey HC. Emergency management of poisoning. Pediatr Clin North Am. 1970 Aug;17(3):525–534. [PubMed]
  • Dorwart WV, Chalmers L. Comparison of methods for calculating serum osmolality form chemical concentrations, and the prognostic value of such calculations. Clin Chem. 1975 Feb;21(2):190–194. [PubMed]
  • Máttar JA, Weil MH, Shubin H, Stein L. Cardiac arrest in the critically ill. II. Hyperosmolal states following cardiac arrest. Am J Med. 1974 Feb;56(2):162–168. [PubMed]
  • SOTOS JF, DODGE PR, TALBOT NB. Studies in experimental hypertonicity. II. Hypertonicity of body fluids as a cause of acidosis. Pediatrics. 1962 Aug;30:180–193. [PubMed]
  • 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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