Resident Journal Review: Neurologic Complications of Correction for Hyperglycemic Hyperosmolar State in the Emergency Department

Authors: Mark Sutherland, MD, Megan Donohue, MD, Caleb Chan, MD, Robert Brown, MD

Editors: Kami M. Hu, MD FAAEM; Kelly Maurelus, MD FAAEM

Originally published: Common Sense September/October  2019

Questions

1. What is the preferred therapy for correction of hyperglycemic hyperosmolar states (HHS) in the emergency department, and what potential adverse neurologic effects of these corrective therapies should be considered?
2. What is the incidence of osmotic demyelination syndrome (ODS) or cerebral edema when aggressively correcting hyperglycemic states?
3. Who is at greatest risk for ODS and what can be done to reduce their risk?
4. Who is at greatest risk for cerebral edema and what can be done to reduce their risk?