2018 Volume 51 Issue 3 Pages 223-228
We present two cases of severe hyperglycemia in hemodialysis patients with type 2 diabetes mellitus. Case 1 involved a 65-year-old male. Although his blood glucose level was 972 mg/dL, his calculated effective osmolality (without urea) was <320 mOsm/L. The hyperglycemia was promptly improved by insulin treatment and hemodialysis. Case 2 involved a 90-year-old female patient with convulsive seizures and loss of consciousness. She was receiving continuous tube feeding. Her blood glucose level was 994 mg/dL, and her effective plasma osmolality was 321 mOsm/L. She was diagnosed with a hyperosmolar hyperglycemic state. She did not undergo hemodialysis during her hospitalization. Although her hyperglycemia was only treated with insulin, it took time for her blood glucose level to improve, and she had a high insulin requirement. Even in patients with severe hyperglycemia, plasma osmotic pressure values can be affected by whether the patient drinks water before developing symptoms. Hemodialysis and insulin treatment promptly improved hyperglycemia in these cases.
