EVALUATION OF HYDRATION STATUS OF PATIENTS WITH HYPERGLYCEMIA

[摘要] Background:  Acute hyperglycemia increases serum osmolality which leads to a rapid decline in serum sodium levels.  Consequently, assessment of hydration status in individuals with hyperglycemia remains difficult. The goal of this study was to compare common equations that estimate osmolality to measured serum osmolality in patients hospitalized with hyperglycemia. Methods:  In this cross-sectional study, data was collected from adult patients with serum glucose levels greater than 200 mg/dL.  Serum osmolality was measured directly and compared to osmolality estimates using the Dorwart equation and the Rasouli equation.  Sodium correction factors for hyperglycemia of 1.6 and 2.4 were also utilized for each equation, yielding six total equations.  Patients greater than 18 years of age with measured serum osmolality ≥ 295 mOsm/L were included in the analysis.  Regression analysis was performed in order to determine the best equation to predict hydration status of patients with hyperglycemia. Results:  A total of 195 hospitalized adults with hyperglycemia were evaluated for inclusion in the study.  Twelve of 195 hyperglycemic patients had normal hydration (serum osmolality 280-294 mOsm/L), and thus were excluded from the analysis.  Among the equations utilized, the Rasouli equation utilizing a sodium correction factor of 2.4 was the most accurate predictor of dehydration, correctly identifying 94% of those patients. Conclusions:  The two commonly used equations to estimate osmolality consistently underestimated the actual measured osmolality level of patients with hyperglycemia. The Rasouli equation utilizing a sodium correction factor of 2.4 was the most accurate equation for predicting measured osmolality; however, it still tended to underestimate osmolality. In order to determine the hydration status of patients with hyperglycemia rapidly, we recommend direct measurement of serum osmolality.

[学科分类] 基础医学

[关键词] Hyperglycemia;Osmolality;Sodium;Hyponatremia