Hyperosmolar Nonketotic Syndrome

Surgical patients with diabetes and impaired glucose tolerance are susceptible to volume depletion and electrolyte imbalance leading to the hyperosmolar nonketotic syndrome. Intravenous fluids are required to replace the pre-existing volume deficient, hemorrhage, third-space losses, GI losses, and the ongoing osmotic diuresis. Appropriate attention to intravascular volume will facilitate hepatic/renal blood flow and correction of the hyperosmolar condition. Placement of a pulmonary artery catheter and/or transesophageal endoscope (TEE) may provide useful data to guide fluid management, especially in the diabetic with renal insufficiency or decreased cardiac reserve (31).

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