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To the Editor: In their article on the physical diagnosis of hypovolemia, Dr McGee and colleagues¹ correctly state that dehydration refers to "the losses of intracellular water that ultimately cause cellular desiccation and elevate the plasma sodium concentration and osmolality." The authors note that while patients with pure dehydration may lack circulatory instability, most patients presenting with dehydration also have hypovolemia. Furthermore, they indicate that patients with pure dehydration should receive 5% dextrose, usually more slowly than patients with hypovolemia, who require a rapid infusion of 0.9% saline.

In the case of patients with diabetic hyperglycemic hyperosmolarity, inadequate or incorrect fluid replacement may result in the conversion of dehydration to hypovolemia, referred to as the "latent shock of dehydration."² Patients with diabetic hyperglycemic hyperosmolarity typically present with hyperosmolarity, often without hypernatremia (unless the sodium concentration is corrected by using one of a number of estimates, such as that of Katz,³ . . . [Full Text of this Article]