Webb A K, Phillips M J, Hanson G C
J R Soc Med. 1979 Aug;72(8):578-86. doi: 10.1177/014107687907200807.
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.
本文报告了4例医源性非糖尿病高渗状态病例。讨论了其临床表现、生化检查结果及治疗方法。不应以高于患者耐受水平的速度输注高渗溶液；应避免用高渗溶液冲洗中空脏器，且不应使用盐类催吐剂。处于应激状态的患者尤其易患此病，主要原因是循环皮质醇水平较高。使用皮质类固醇、给予超出患者需要量的含盐水溶液、水分缺失以及在缺乏仔细生化监测的情况下进行静脉营养，都是可能在危重症患者中诱发高渗状态的因素。
