CLINICAL CASE 66: Answers and Summary

ESRD PATIENT ON HEMODIALYSIS PRESENTS WITH HYPERGLYCEMIA OF 800. HOW WILL YOU TREAT?

Severe hyperglycemia in oliguric or anuric ESRD patients is not associated with features of a glucose-related osmotic diuresis as is seen in other patients but is more likely to be associated with hyponatremia, hyperkalemia, and acute intravascular volume expansion and instead of giving fluids and insulin, one must resort to good insulin therapy and prompt dialysis. A prior post discusses this in more detail. Hence the most appropriate answer is Insulin and dialysis.