HYPEROSMOLAR STATES IN CHRONICALLY ILL

Three chronically ill patients with hyperosmolar states of different origin were studied. The discussion involves hyperglycemic nonketotic coma, coma due to tube feeding of high-protein nutrients, and hyperosmolality following diuretic administration and an inadequate intake of fluids. The hypertonic dehydration of these patients was caused by a deficit of water and an excess of solutes. Common to all 3 cases were urinary-tract infections with probable pyelonephritis. The loss of concentrating power in the pyelonephritic kidney results in a reduction of the ability to conserve body water. In older patients, there is an increase in the obligatory water loss via the urine because tubular function in the aging arteriosclerotic kidney is diminished. Other important factors in the pathogenesis of hyperosmolar states are fever, infection, inability to respond to thirst, impairment of glucose tolerance, and the frequent use of diuretics. The essential elements of management are early recognition and prompt correction with hypotonic solutions. © 1969 The American Geriatrics Society.