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November 10, 1999, Vol 282, No. 18 >

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Letters | November 10, 1999

Hypovolemia in Patients With Hyperglycemia—Reply

Steve McGee, MD; William B. Abernethy III, MD
JAMA. 1999;282(18):1720-1721. doi:10-1001/pubs.JAMA-ISSN-0098-7484-282-18-jbk1110.
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In Reply: We agree with Dr Matz that in patients with hyperglycemia, the serum sodium level no longer reflects the degree of dehydration, which would be much better assessed by the calculated effective osmolality. None of the studies in our article used effective osmolality as a criterion standard, although we believe few if any of the patients had hyperglycemia as a cause of their dehydration. We also agree that it would be unwise to treat the hyperglycemic patient with only 5% dextrose because unless the patient has renal failure and is unable to have an osmotic diuresis, most hyperglycemic patients also have volume depletion. Hillier et al1 recently suggested that in hyperglycemic patients, the physiologic decrease in sodium concentration may be considerably greater than the standard correction factor of 1.6 mmol/L of sodium per 5.6 mmol/L (100 mg/dL) of glucose.

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