Physiopathology and management of hyperosmolar hyperglycemic nonketotic dehydration.

Results of a review of the clinical course of five patients in whom hyperosmotic hyperglycemic nonketotic dehydration developed suggests that a treatment regimen of a high dosage of insulin and free water administration may not be effective. Analysis of the physiopathology of the syndrome points to sodium and water deficits as the principal cause of symptoms. A rapid lowering of the blood glucose level may be detrimental, since this leads to an osmotic gradient between the central nervous system and the intravascular space. Treatment should be directed at the rapid replacement of sodium and water with minimal administration of insulin. This treatment plan allows restoration of membrane potentials by an adequate supply of sodium and maintains osmotic equilibrium by providing diffusable sodium to compensate for the osmotic gradient associated with a gradual lowering of the blood glucose level.