Hyperosmolar Hyperglycemic Non-Ketotic Dehydration. Etiology, Pathophysiology and Prevention during Total Parenteral Alimentation,

Records of 200 patients, nutritionally supported by synthetic means, were reviewed for evidence of clinical HHND. A 3 incidence of morbidity with a single mortality was discovered. Examination of the laboratory values of these patients demonstrated a 100 positive correlation between persistent glucosuria and HHND. The pathophysiology of HHND is discussed, demonstrating a relative hypoinsulinism, with insulin sufficient to prevent lypolysis but insufficient to prevent hyperglycemia, glucosuria, and osmotic diuresis. Special reference is made to the mechanisms and management of the pseudodiabetes of stress. It is concluded that HHND is an entirely avoidable iatrogenic morbidity. Prevention of osmotic diuresis, secondary to glucosuria, and therefore prevention of HHND, is achieved by providing exogenous insulin sufficient to prevent glucosuria.