Physical Findings

Ihe physical manifestations associated with HHNS are nonspecific. Generally, clinical signs of volume depletion such as poor skin turgor, dry mucous membranes, sunken eyeballs, and orthostatic hypotension, will correlate with degree of hyperglycemia and hyperosmolality and duration of physiologic imbalance.

A wide range of findings from subtle changes in vital signs and cognition to clear evidence of profound shock and coma may occur. HHNS may unexpectedly be found in patients who present with concurrent medical insults such as an acute cerebrovascular accident (CVA), severe burns, myocardial infarction, infection, pancreatitis, or other acute illness (Iaible 2.05"). Up to 15 percent may present with seizures. Ihese are typically focal, though generalized seizures, which are often resistant to anticonvulsants, may occur.6

Other central nervous system (CNS) symptoms may include tremor, clonus, hyperreflexia or hyporeflexia, a positive plantar response, reversible hemiplegia, or hemisensory defects (without CVA or structural intracerebral lesion). Ihe degree of lethargy and coma is proportional to the level of osmolality. 78 Ihose with coma tend to have higher osmolarity, hyperglycemia, and greater volume contraction. In view of the age of the patient population, it is not surprising that the misdiagnosis of stroke or organic brain disease is common.

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