PubMed · 3509242
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1987. [Infusion fluids].. https://pubmed.ncbi.nlm.nih.gov/3509242/
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Hyperglycemic hyperosmolarity is part of a clinical spectrum of severe hyperglycemic disorders ranging from pure hyperglycemic hyperosmolarity without ketosis to diabetic ketoacidosis, with significant overlap in the middle. From 50 to 75 percent of hospitalizable patients who have uncontrolled diabetes present with significant hyperosmolarity. An altered state of consciousness attributable to uncontrolled diabetes is virtually always the result of severe hyperosmolar hyperglycemia. The linchpin of therapy is prompt, rapid administration of crystalloid solutions that have tonicity appropriate to the level of hyperosmolarity. A decrease in the plasma glucose concentration indicates the adequacy of therapy, especially rehydration; the goal is for the plasma glucose level to decline by at least 75 to 100 mg per dL (4.2 to 5.6 mmol per L) per hour. Patients with hyperosmolar hyperglycemic syndrome are often chronically ill, and they may have major total body deficits of potassium, phosphate and magnesium, as well as B-complex vitamins (especially thiamine). These deficits also require attention and correction during therapy.
Object of this review is to present the physiological principles, diagnostic techniques and therapeutic options that are related to modifications of oxygen delivery in sepsis. Despite intense research activities in this area, many topics regarding oxygen transport and oxygen consumption in sepsis are still not clear. For example, the often discussed shift of the critical value of oxygen delivery to higher values in sepsis has not been proven, yet. Beside an impaired regional perfusion also disturbances in the cellular oxygen utilization may be responsible for organ failure in sepsis. Until now, it was not shown, whether the increase of oxygen delivery to supranormal levels reduces mortality in septic patients. It is also unknown, which catecholamine and which infusion solution is suitable for the treatment of septic patients. In future further research is necessary to solve the problems associated with sepsis therapy.