Hyperosmolar Coma

Authors: Jonathan Rosenzweig John W Broviac

Publish Date: 1972/09/11

Volume: 221, Issue: 11, Pages: 1278-1278

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Abstract

To the Editor—  In the recent article by Curtis et al entitled ChlorthalidoneInduced Hyperosmolar Nonketotic Coma 2201592 1972 the authors describe clearly the course of events in a wellmanaged case However in discussing the fluid and electrolyte imbalances there appears the usual confusion of many physicians over the classification of sodium and water imbalances that in this particular case resulted in the reader being misinformed or confusedFrom the article by Burnell et al1 using the classifications of sodium and water disorders developed there the patient on admission had mild water depletion as evidenced by an initial corrected serum sodium concentration of 141 mEq/liter This correction is particularly pertinent to understanding the case and is arrived at in the following wayWhen the blood glucose level becomes elevated it holds water in the extracellular space since it is confined to that space just as sodium is As water is drawn

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