Plasma sodium changes in the hyperglycaemic state: Clinical aspects of pathophysiology and management

Plasma sodium changes are commonly encountered in hospitalised patients, including diabetics. Nonketotic hyperglycaemic hyperosmolar syndrome (HHS) is mostly found in uncontrolled type 2 diabetes mellitus. This condition represents a metabolic emergency carrying a high mortality. HHS is characterised by extreme dehydration and neurological symptoms. Plasma sodium changes play a significant role in the presentation and prognosis of HHS, making their effective management mandatory. In this review, we consider the pathophysiology of HHS-related sodium abnormalities together with the relevant clinical presentation. We also describe the diagnostic approach and therapeutic strategies.