J.Jpn. Surg. Soc.. 80(7): 627-637, 1979

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Original article

POSTOPERATIVE HYPEROSMOLALITY IN SURGICAL PATIENTS
－Analysis of 65 Patients－

Sixty-five postoperative hyperosmolar patients were analyzed in terms of etiology and prognosis.The following conclusions were obtained.
1. The patients were classified into 6 groups according to the etiology. Group I : transient impairment of glucose tolerance, Group II : dehydration, Group III : hypercatabolic state, Group IV : hyperosmolar nonketotic diabetic coma, Group V : acute renal failure, and Group VI : etiology unknown.
2. Over-all hospital mortality was 29.2%. Deaths were encountered in the groups except I and IV. Since hyperosmolar state in Group V was considered secondary event to renal failure, it was exeluded from this analysis and only a primary hyperosmolar state was analyzed. Death cases in primary hyperosmolar patients (Groups II, III, and IV) were characterized by advanced age, maleness and abnormally high Posm・max. Sixty percent of deaths in primary hyperosmolar patients was caused by acute renal failure subsequent to hyperosmolality.
3. Retrospective analysis of death cases showed plasma osmolality (Posm) remained increased above 350 mOsm/kg. H₂O even 48-72 hours before deaths indicating persistence of high Posm above 350 mOsm/kg. H₂O to be a poor prognostic index.
4. Analysis of difference (Osm-D) between actually measured values of Posm and calculated Posm from formula indicated Osm-D to be not reliable prognostic index in the hyperosmolar patients

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