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Liang M, Xu Y, Ren X, Huang D, Jin M, Qiu Z. The U-shaped association between serum osmolality and 28-day mortality in patients with sepsis: a retrospective cohort study. Infection 2024:10.1007/s15010-024-02256-3. [PMID: 38647828 DOI: 10.1007/s15010-024-02256-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/01/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Sepsis is a recognized global health challenge that places a considerable disease burden on countries. Although there has been some progress in the study of sepsis, the mortality rate of sepsis remains high. The relationship between serum osmolality and the prognosis of patients with sepsis is unclear. METHOD Patients with sepsis who met the criteria in the Medical Information Mart for Intensive Care IV database were included in the study. Hazard ratios (HRs) and 95% confidence intervals (CIs) were determined using multivariable Cox regression. The relationship between serum osmolality and the 28-day mortality risk in patients with sepsis was investigated using curve fitting, and inflection points were calculated. RESULTS A total of 13,219 patients with sepsis were enrolled in the study; the mean age was 65.1 years, 56.9 % were male, and the 28-day mortality rate was 18.8 %. After adjusting for covariates, the risk of 28-day mortality was elevated by 99% (HR 1.99, 95%CI 1.74-2.28) in the highest quintile of serum osmolality (Q5 >303.21) and by 59% (HR 1.59, 95%CI 1.39-1.83) in the lowest quintile (Q1 ≤285.80), as compared to the reference quintile (Q3 291.38-296.29). The results of the curve fitting showed a U-shaped relationship between serum osmolality and the risk of 28-day mortality, with an inflection point of 286.9 mmol/L. CONCLUSION There is a U-shaped relationship between serum osmolality and the 28-day mortality risk in patients with sepsis. Higher or lower serum osmolality is associated with an increased risk of mortality in patients with sepsis. Patients with sepsis have a lower risk of mortality when their osmolality is 285.80-296.29 mmol/L.
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Affiliation(s)
- Minghao Liang
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China.
| | - Yifei Xu
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xiuhong Ren
- Qilu Hospital of Shandong University, Jinan, China
| | - Di Huang
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Minyan Jin
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Zhanjun Qiu
- The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China.
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2
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Bøgwald I, Østbye TKK, Pedersen AM, Rønning SB, Dias J, Eilertsen KE, Wubshet SG. Calanus finmarchicus hydrolysate improves growth performance in feeding trial with European sea bass juveniles and increases skeletal muscle growth in cell studies. Sci Rep 2023; 13:12295. [PMID: 37516761 PMCID: PMC10387114 DOI: 10.1038/s41598-023-38970-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/18/2023] [Indexed: 07/31/2023] Open
Abstract
The world will be dependent on the development of novel feed ingredients from renewable sources to ensure sustainable growth of the aquaculture industry. Zooplankton like Calanus finmarchicus are viable new raw material candidates, as they have optimal nutrient profiles for aquatic animals and may be sustainably harvested in large volumes. In this study, the aim was to investigate if a protein hydrolysate of C. finmarchicus was able to influence the growth performance of fish. The effect of dietary inclusion of hydrolysates was tested in a feeding trial with European sea bass (Dicentrarchus labrax) juveniles, benchmarking calanus hydrolysate (CH) against commercially available hydrolysates. The diet with CH inclusion yielded increased growth, with significantly higher body weight than hydrolysates of sardine and tuna fish at the end of the trial. The observed growth-promoting effects were further examined using an in vitro model with skeletal muscle cells from Atlantic salmon. Through bioactivity experiments with muscle cells grown in media containing CH, low-molecular fractions were found to have the greatest positive effect on proliferation, viability, and expression of muscle-specific genes. Characterization of the most potent fraction revealed an abundance of small peptides, along with amino acids and marine metabolites associated with increased muscle growth.
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Affiliation(s)
- Isak Bøgwald
- The Norwegian College of Fishery Science, UIT-The Arctic University of Norway, P.O. box 6050, 9037, Tromsø, Norway.
- Calanus AS, P.O. box 808, 9258, Tromsø, Norway.
| | - Tone-Kari K Østbye
- Nofima AS-The Norwegian Institute of Food, Fisheries and Aquaculture Research, Osloveien 1, 1430, Ås, Norway
| | | | - Sissel Beate Rønning
- Nofima AS-The Norwegian Institute of Food, Fisheries and Aquaculture Research, Osloveien 1, 1430, Ås, Norway
| | - Jorge Dias
- SPAROS Lda, Área Empresarial de Marim, Lote C, 8700-221, Olhão, Portugal
| | - Karl-Erik Eilertsen
- The Norwegian College of Fishery Science, UIT-The Arctic University of Norway, P.O. box 6050, 9037, Tromsø, Norway
| | - Sileshi Gizachew Wubshet
- Nofima AS-The Norwegian Institute of Food, Fisheries and Aquaculture Research, Osloveien 1, 1430, Ås, Norway
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3
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Höglsperger F, Vos BE, Hofemeier AD, Seyfried MD, Stövesand B, Alavizargar A, Topp L, Heuer A, Betz T, Ravoo BJ. Rapid and reversible optical switching of cell membrane area by an amphiphilic azobenzene. Nat Commun 2023; 14:3760. [PMID: 37353493 PMCID: PMC10290115 DOI: 10.1038/s41467-023-39032-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/25/2023] [Indexed: 06/25/2023] Open
Abstract
Cellular membrane area is a key parameter for any living cell that is tightly regulated to avoid membrane damage. Changes in area-to-volume ratio are known to be critical for cell shape, but are mostly investigated by changing the cell volume via osmotic shocks. In turn, many important questions relating to cellular shape, membrane tension homeostasis and local membrane area cannot be easily addressed because experimental tools for controlled modulation of cell membrane area are lacking. Here we show that photoswitching an amphiphilic azobenzene can trigger its intercalation into the plasma membrane of various mammalian cells ranging from erythrocytes to myoblasts and cancer cells. The photoisomerization leads to a rapid (250-500 ms) and highly reversible membrane area change (ca 2 % for erythrocytes) that triggers a dramatic shape modulation of living cells.
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Affiliation(s)
- Fabian Höglsperger
- Organic Chemistry Institute, University of Münster, Münster, Germany
- Center for Soft Nanoscience, University of Münster, Münster, Germany
| | - Bart E Vos
- Third Institute of Physics-Biophysics, University of Göttingen, Göttingen, Germany
| | - Arne D Hofemeier
- Third Institute of Physics-Biophysics, University of Göttingen, Göttingen, Germany
| | - Maximilian D Seyfried
- Organic Chemistry Institute, University of Münster, Münster, Germany
- Center for Soft Nanoscience, University of Münster, Münster, Germany
| | - Bastian Stövesand
- Organic Chemistry Institute, University of Münster, Münster, Germany
- Center for Soft Nanoscience, University of Münster, Münster, Germany
| | - Azadeh Alavizargar
- Institute of Physical Chemistry, University of Münster, Münster, Germany
| | - Leon Topp
- Institute of Physical Chemistry, University of Münster, Münster, Germany
| | - Andreas Heuer
- Center for Soft Nanoscience, University of Münster, Münster, Germany
- Institute of Physical Chemistry, University of Münster, Münster, Germany
| | - Timo Betz
- Third Institute of Physics-Biophysics, University of Göttingen, Göttingen, Germany.
| | - Bart Jan Ravoo
- Organic Chemistry Institute, University of Münster, Münster, Germany.
- Center for Soft Nanoscience, University of Münster, Münster, Germany.
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4
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Büyükkaragöz B, Bakkaloğlu SA. Serum osmolality and hyperosmolar states. Pediatr Nephrol 2023; 38:1013-1025. [PMID: 35779183 DOI: 10.1007/s00467-022-05668-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/26/2022] [Accepted: 06/14/2022] [Indexed: 11/26/2022]
Abstract
Serum osmolality is the sum of the osmolalities of every single dissolved particle in the blood such as sodium and associated anions, potassium, glucose, and urea. Under normal conditions, serum sodium concentration is the major determinant of serum osmolality. Effective blood osmolality, so-called blood tonicity, is created by the endogenous (e.g., sodium and glucose) and exogenous (e.g., mannitol) solutes that are capable of creating an osmotic gradient across the membranes. In case of change in effective blood osmolality, water shifts from the compartment with low osmolality into the compartment with high osmolarity in order to restore serum osmolality. The difference between measured osmolality and calculated osmolarity forms the osmolal gap. An increase in serum osmolal gap can stem from the presence of solutes that are not included in the osmolarity calculation, such as hypertonic treatments or toxic alcoholic ingestions. In clinical practice, determination of serum osmolality and osmolal gap is important in the diagnosis of disorders related to sodium, glucose and water balance, kidney diseases, and small molecule poisonings. As blood hypertonicity exerts its main effects on the brain cells, neurologic symptoms varying from mild neurologic signs and symptoms to life-threatening outcomes such as convulsions or even death may occur. Therefore, hypertonic states should be promptly diagnosed and cautiously managed. In this review, the causes and treatment strategies of hyperosmolar conditions including hypernatremia, diabetic ketoacidosis, hyperglycemic hyperosmolar syndrome, hypertonic treatments, or intoxications are discussed in detail to increase awareness of this important topic with significant clinical consequences.
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Affiliation(s)
- Bahar Büyükkaragöz
- Department of Pediatric Nephrology, Gazi University, 06560, Besevler, Ankara, Turkey.
| | - Sevcan A Bakkaloğlu
- Department of Pediatric Nephrology, Gazi University, 06560, Besevler, Ankara, Turkey
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Rohrscheib M, Sam R, Raj DS, Argyropoulos CP, Unruh ML, Lew SQ, Ing TS, Levin NW, Tzamaloukas AH. Edelman Revisited: Concepts, Achievements, and Challenges. Front Med (Lausanne) 2022; 8:808765. [PMID: 35083255 PMCID: PMC8784663 DOI: 10.3389/fmed.2021.808765] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
The key message from the 1958 Edelman study states that combinations of external gains or losses of sodium, potassium and water leading to an increase of the fraction (total body sodium plus total body potassium) over total body water will raise the serum sodium concentration ([Na]S), while external gains or losses leading to a decrease in this fraction will lower [Na]S. A variety of studies have supported this concept and current quantitative methods for correcting dysnatremias, including formulas calculating the volume of saline needed for a change in [Na]S are based on it. Not accounting for external losses of sodium, potassium and water during treatment and faulty values for body water inserted in the formulas predicting the change in [Na]S affect the accuracy of these formulas. Newly described factors potentially affecting the change in [Na]S during treatment of dysnatremias include the following: (a) exchanges during development or correction of dysnatremias between osmotically inactive sodium stored in tissues and osmotically active sodium in solution in body fluids; (b) chemical binding of part of body water to macromolecules which would decrease the amount of body water available for osmotic exchanges; and (c) genetic influences on the determination of sodium concentration in body fluids. The effects of these newer developments on the methods of treatment of dysnatremias are not well-established and will need extensive studying. Currently, monitoring of serum sodium concentration remains a critical step during treatment of dysnatremias.
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Affiliation(s)
- Mark Rohrscheib
- Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Ramin Sam
- Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco School of Medicine, San Francisco, CA, United States
| | - Dominic S Raj
- Department of Medicine, George Washington University, Washington, DC, United States
| | - Christos P Argyropoulos
- Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Mark L Unruh
- Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Susie Q Lew
- Department of Medicine, George Washington University, Washington, DC, United States
| | - Todd S Ing
- Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, United States
| | - Nathan W Levin
- Mount Sinai Icahn School of Medicine, New York, NY, United States
| | - Antonios H Tzamaloukas
- Research Service, Department of Medicine, Raymond G. Murphy Veterans Affairs Medical Center and University of New Mexico School of Medicine, Albuquerque, NM, United States
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6
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Afshar N, Safaei S, Nickerson DP, Hunter PJ, Suresh V. Computational Modelling of Glucose Uptake by SGLT1 and Apical GLUT2 in the Enterocyte. Front Physiol 2021; 12:699152. [PMID: 34950044 PMCID: PMC8688934 DOI: 10.3389/fphys.2021.699152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 11/04/2021] [Indexed: 11/18/2022] Open
Abstract
It has been suggested that glucose absorption in the small intestine depends on both constitutively expressed SGLT1 and translocated GLUT2 in the brush border membrane, especially in the presence of high levels of luminal glucose. Here, we present a computational model of non-isotonic glucose uptake by small intestinal epithelial cells. The model incorporates apical uptake via SGLT1 and GLUT2, basolateral efflux into the blood via GLUT2, and cellular volume changes in response to non-isotonic conditions. The dependence of glucose absorption on luminal glucose, blood flow rate, and inlet blood glucose concentration is studied. Uptake via apical GLUT2 is found to be sensitive to all these factors. Under a range of conditions, the maximum apical GLUT2 flux is about half of the SGLT1 flux and is achieved at high luminal glucose (> 50 mM), high blood flow rates, and low inlet blood concentrations. In contrast, SGLT1 flux is less sensitive to these factors. When luminal glucose concentration is less than 10 mM, apical GLUT2 serves as an efflux pathway for glucose to move from the blood to the lumen. The model results indicate that translocation of GLUT2 from the basolateral to the apical membrane increases glucose uptake into the cell; however, the reduction of efflux capacity results in a decrease in net absorption. Recruitment of GLUT2 from a cytosolic pool elicits a 10–20% increase in absorption for luminal glucose levels in the a 20–100 mM range. Increased SGLT1 activity also leads to a roughly 20% increase in absorption. A concomitant increase in blood supply results in a larger increase in absorption. Increases in apical glucose transporter activity help to minimise cell volume changes by reducing the osmotic gradient between the cell and the lumen.
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Affiliation(s)
- Nima Afshar
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Soroush Safaei
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - David P Nickerson
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Peter J Hunter
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Vinod Suresh
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand.,Department of Engineering Science, University of Auckland, Auckland, New Zealand
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Dialysis-associated hyperglycemia: manifestations and treatment. Int Urol Nephrol 2020; 52:505-517. [PMID: 31955362 DOI: 10.1007/s11255-019-02373-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 12/23/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE Dialysis-associated hyperglycemia (DAH), is associated with a distinct fluid and electrolyte pathophysiology. The purpose of this report was to review the pathophysiology and provide treatment guidelines for DAH. METHODS Review of published reports on DAH. Synthesis of guidelines based on these reports. RESULTS The following fluid and solute abnormalities have been identified in DAH: (a) hypoglycemia: this is a frequent complication of insulin treatment and its prevention requires special attention. (b) Elevated serum tonicity. The degree of hypertonicity in DAH is lower than in similar levels of hyperglycemia in patients with preserved renal function. Typically, correction of hyperglycemia with insulin corrects the hypertonicity of DAH. (c) Extracellular volume abnormalities ranging from pulmonary edema associated with osmotic fluid shift from the intracellular into the extracellular compartment as a consequence of gain in extracellular solute (glucose) to hypovolemia from osmotic diuresis in patients with residual renal function or from fluid losses through extrarenal routes. Correction of DAH by insulin infusion reverses the osmotic fluid transfer between the intracellular and extracellular compartments and corrects the pulmonary edema, but can worsen the manifestations of hypovolemia, which require saline infusion. (d) A variety of acid-base disorders including ketoacidosis correctable with insulin infusion and no other interventions. (e) Hyperkalemia, which is frequent in DAH and is more severe when ketoacidosis is also present. Insulin infusion corrects the hyperkalemia. Extreme hyperkalemia at presentation or hypokalemia developing during insulin infusion require additional measures. CONCLUSIONS In DAH, insulin infusion is the primary management strategy and corrects the fluid and electrolyte abnormalities. Patients treated for DAH should be monitored for the development of hypoglycemia or fluid and electrolyte abnormalities that may require additional treatments.
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Tzamaloukas AH, Khitan ZJ, Glew RH, Roumelioti ME, Rondon-Berrios H, Elisaf MS, Raj DS, Owen J, Sun Y, Siamopoulos KC, Rohrscheib M, Ing TS, Murata GH, Shapiro JI, Malhotra D. Serum Sodium Concentration and Tonicity in Hyperglycemic Crises: Major Influences and Treatment Implications. J Am Heart Assoc 2019; 8:e011786. [PMID: 31549572 PMCID: PMC6806024 DOI: 10.1161/jaha.118.011786] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Antonios H Tzamaloukas
- Raymond G. Murphy Veterans Affairs Medical Center Albuquerque NM.,University of New Mexico School of Medicine Albuquerque NM
| | - Zeid J Khitan
- Joan C. Edwards School of Medicine Marshall University Huntington WV
| | - Robert H Glew
- University of New Mexico School of Medicine Albuquerque NM
| | | | | | - Moses S Elisaf
- University of Ioannina School of Medicine Ioannina Greece
| | - Dominic S Raj
- George Washington University School of Medicine Washington DC
| | - Jonathan Owen
- University of New Mexico School of Medicine Albuquerque NM
| | - Yijuan Sun
- Raymond G. Murphy Veterans Affairs Medical Center Albuquerque NM.,University of New Mexico School of Medicine Albuquerque NM
| | | | | | - Todd S Ing
- Stritch School of Medicine Loyola University Chicago Maywood IL
| | - Glen H Murata
- Raymond G. Murphy Veterans Affairs Medical Center Albuquerque NM
| | - Joseph I Shapiro
- Joan C. Edwards School of Medicine Marshall University Huntington WV
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Roumelioti ME, Ing TS, Rondon-Berrios H, Glew RH, Khitan ZJ, Sun Y, Malhotra D, Raj DS, Agaba EI, Murata GH, Shapiro JI, Tzamaloukas AH. Principles of quantitative water and electrolyte replacement of losses from osmotic diuresis. Int Urol Nephrol 2018; 50:1263-1270. [PMID: 29511980 DOI: 10.1007/s11255-018-1822-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 02/04/2018] [Indexed: 02/08/2023]
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Rondon-Berrios H, Argyropoulos C, Ing TS, Raj DS, Malhotra D, Agaba EI, Rohrscheib M, Khitan ZJ, Murata GH, Shapiro JI, Tzamaloukas AH. Hypertonicity: Clinical entities, manifestations and treatment. World J Nephrol 2017; 6:1-13. [PMID: 28101446 PMCID: PMC5215203 DOI: 10.5527/wjn.v6.i1.1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/17/2016] [Accepted: 11/02/2016] [Indexed: 02/06/2023] Open
Abstract
Hypertonicity causes severe clinical manifestations and is associated with mortality and severe short-term and long-term neurological sequelae. The main clinical syndromes of hypertonicity are hypernatremia and hyperglycemia. Hypernatremia results from relative excess of body sodium over body water. Loss of water in excess of intake, gain of sodium salts in excess of losses or a combination of the two are the main mechanisms of hypernatremia. Hypernatremia can be hypervolemic, euvolemic or hypovolemic. The management of hypernatremia addresses both a quantitative replacement of water and, if present, sodium deficit, and correction of the underlying pathophysiologic process that led to hypernatremia. Hypertonicity in hyperglycemia has two components, solute gain secondary to glucose accumulation in the extracellular compartment and water loss through hyperglycemic osmotic diuresis in excess of the losses of sodium and potassium. Differentiating between these two components of hypertonicity has major therapeutic implications because the first component will be reversed simply by normalization of serum glucose concentration while the second component will require hypotonic fluid replacement. An estimate of the magnitude of the relative water deficit secondary to osmotic diuresis is obtained by the corrected sodium concentration, which represents a calculated value of the serum sodium concentration that would result from reduction of the serum glucose concentration to a normal level.
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