Hyperosmolar coma

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  1. Characterized by extreme hyperglycemia, severe dehydration, and marked hyperosmolarity without ketoacidosis; free fatty acid concentration is lower than in ketoacidosis; glucose concentration is higher than in ketoacidosis
  2. Typically seen in elderly patients with NIDDM precipitated by infection or stress; may also be precipitated by phenytoin or TPN using hypertonic glucose solutions
  3. Clinical: lethargy, delirium, coma, focal or generalized seizures, visual changes, hemiparesis, sensory deficits
  4. Treatment: fluid and insulin; mortality is 10-20%
  5. Osmolality = 2 x (Na + K) + BUN/2.8 + glucose/18
    1. Remember: BUN has 3 letters and is divided by ~3 (2.8)
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