Hyperosmolar Coma Medication

  • Author: Joseph Michael Gonzalez-Campoy, MD, PhD, FACE; Chief Editor: George T Griffing, MD   more...
 
Updated: Aug 2, 2011
 

Medication Summary

Insulin and intravenous fluid management are cornerstones in the management of HNS. Aggressive rehydration with intravenous fluids, including isotonic sodium chloride solution, is indicated in every patient with HNS (see Medical Care). Frequently monitoring electrolyte concentrations is indicated when patients are treated with intravenous fluids. Volume overload is the only other potential problem when treating patients with intravenous fluids; therefore, regular assessment of the hydration state is indicated.

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Antihyperglycemic agents

Class Summary

Reduce serum glucose concentration.

Insulin regular human (Humulin, Novolin)

 

Stimulates proper use of glucose by cells and reduces blood sugar levels.

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Contributor Information and Disclosures
Author

Joseph Michael Gonzalez-Campoy, MD, PhD, FACE  Medical Director and CEO, Minnesota Center for Obesity, Metabolism, and Endocrinology

Joseph Michael Gonzalez-Campoy, MD, PhD, FACE is a member of the following medical societies: American Association of Clinical Endocrinologists, Association of Clinical Researchers and Educators (ACRE), and Minnesota Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

David S Schade, MD  Chief, Division of Endocrinology and Metabolism, Professor, Department of Internal Medicine, University of New Mexico School of Medicine and Health Sciences Center

David S Schade, MD is a member of the following medical societies: American College of Physicians, American Diabetes Association, American Federation for Medical Research, Endocrine Society, New Mexico Medical Society, New York Academy of Sciences, and Society for Experimental Biology and Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Don S Schalch, MD  Professor Emeritus, Department of Internal Medicine, Division of Endocrinology, University of Wisconsin Hospitals and Clinics

Don S Schalch, MD is a member of the following medical societies: American Diabetes Association, American Federation for Medical Research, Central Society for Clinical Research, and Endocrine Society

Disclosure: Nothing to disclose.

Mark Cooper, MBBS, PhD, FRACP  Head, Diabetes & Metabolism Division, Baker Heart Research Institute, Professor of Medicine, Monash University

Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD  Professor of Medicine, St Louis University School of Medicine

George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

References
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  2. Ahuja N, Palanichamy N, Mackin P, et al. Olanzapine-induced hyperglycaemic coma and neuroleptic malignant syndrome: case report and review of literature. J Psychopharmacol. Nov 21 2008;[Medline].

  3. Bartoli E, Sainaghi PP, Bergamasco L, et al. Hyperosmolar coma due to exclusive glucose accumulation: recognition and computations. Nephrology (Carlton). Apr 2009;14(3):338-44. [Medline].

  4. Bartoli E, Bergamasco L, Castello L, et al. Methods for the quantitative assessment of electrolyte disturbances in hyperglycaemia. Nutr Metab Cardiovasc Dis. Jan 2009;19(1):67-74. [Medline].

  5. Munoz C, Villanueva G, Fogg L, et al. Impact of a subcutaneous insulin protocol in the emergency department: Rush Emergency Department Hyperglycemia Intervention (REDHI). J Emerg Med. May 2011;40(5):493-8. [Medline].

  6. American Diabetes Association. Hospital admission guidelines for diabetes. Diabetes Care. Jan 2004;27 Suppl 1:S103. [Medline]. [Full Text].

  7. Fishbein H, Palumbo PJ. Acute Metabolic Complications in Diabetes. In: National Diabetes Data Group. Diabetes in America. 2nd ed. Bethesda, Md: National Institute of Diabetes and Digestive and Kidney Disease; 1995:283-91.

  8. Gonzalez-Campoy JM, Robertson RP. Diabetic ketoacidosis and hyperosmolar nonketotic state: gaining control over extreme hyperglycemic complications. Postgrad Med. Jun 1996;99(6):143-52. [Medline].

  9. Kitabchi AE, Umpierrez GE, Murphy MB, et al. Hyperglycemic crises in diabetes. Diabetes Care. Jan 2004;27 Suppl 1:S94-102. [Medline]. [Full Text].

  10. Stoner GD. Hyperosmolar hyperglycemic state. Am Fam Physician. May 1 2005;71(9):1723-30. [Medline]. [Full Text].

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