Inverse Distribution of Serum Sodium and Potassium in Uncontrolled Inpatients with Diabetes Mellitus.

Abstract

Abstract.It has been reported that there is an inverse relationship between serum sodium (Na) and potassium (K) levels in patients with diabetic coma. The present study was undertaken to determine whether such an inverse relation depends upon plasma glucose levels in diabetic patients for their glycemic control. We examined two hundred and fifty-two patients with diabetes mellitus admitted to our hospital during the one-year period to control their plasma glucose levels, except for those having nephropathy or liver dysfunction. Serum Na and K, plasma glucose, and serum and urinary C-peptide levels were determined.There was a negative correlation between serum Na levels and fasting plasma glucose (FPG), and, conversely, a positive correlation between serum K levels and FPG. The changes were more evident in the patients with insulin-dependent diabetes mellitus than those with non-insulindependent diabetes mellitus.There was an inverse relation between serum Na and K levels and it was profoundly dependent upon plasma glucose levels in all the diabetic patients before tight control of their glycemic levels. The disorder may be based on the movement of electrolytes between intra-and extracellular spaces, dependent on the impaired insulin action as well as hyperosmolality.

Role of hyperglycemia in the pathogenesis of Na+/K+ disturbance

“…It suggests that distribution of serum Na + and K + is dependent on plasma glucose level. Hyponatraemia was observed in several studies of diabetic patients and our study is in agreement with Jameil NA and Saito, et al 7,8 There are several factors possibly involved in alteration of these electrolytes distribution. Hyperglycemia causes osmotic diuresis, resulting hypovolemia.…”

“…The higher the level of plasma glucose results in the greater depletion in circulating blood volume. 8 Serum Na + is reabsorbed in proximal convoluted tubule of nephron and excessive urination due to hyperglycemia is known to be the mechanical cause of depleted Na + concentration. 7 Hyperosmolality ensuing hyperglycemia causes a relative increase in extracellular fluid derived from interstitial spaces.…”

“…In addition, hyperosmolality promotes cellular dehydration, thus providing an increase in K + efflux from cells into serum. 8 . The activity of this transport protein could be attenuated in diabetic patients suffering from insufficient insulin secretion or insulin resistance.…”

Blood Na+/K+ and Cl- Levels of Hyperglycemic Rats Administered with Traditional Herbal Formulations

“…Also, the poor correlation (r=0.386096385) between SNC and SKC appeared to suggest an inverse relationship between blood levels of Na + and Cl-as exemplified in diabetic coma. 27 The relatively low SNC and SKC of the DIAB group and related treated groups, compared with corresponding NORM group (Figure 1), are evidence of hyponatremia and hypokalemia in the experimental rats. Fittingly, low SNC and SCC of the DIAB group conformed to previous reports.…”

“…Aside from abnormalities of carbohydrate, protein and lipid metabolism, the present study portrays blood electrolytes levels as reliable diagnostic parameters in DM as previously described 5,6,[26][27][28][29] and for monitoring therapeutic events in the course of management of DM. [30][31][32] Alterations in blood electrolytes is a common feature of uncontrolled DM, 5,6,13,14,31 which is exacerbated by diuretics and other medications that lowers body Na + levels and elicits hypovolemia.…”