Glucose-induced paradoxical hyperkalemia in patients with suppression of the renin-aldosterone system: prevention by sodium depletion.
A paradoxical transitory elevation of serum potassium concentration after intravenous infusion of hypertonic glucose has been found in 6 renal and/or hypertensive patients with suppression of the renin-aldosterone system (RAS) while on high sodium intake. Sodium restriction induced a dramatic increase in plasma renin activity (PRA) and/or plasma aldosterone (PA) in every patient, a substantial fall in the elevated serum potassium levels in 4 out of the 6 patients and a marked increase in fractional potassium excretion. During sodium restriction the glucose-induced paradoxical transitory hyperkalemia was abolished. The study confirmed the important extrarenal influence of aldosterone in the maintenance of normal potassium level in the hyperosmolal extracellular fluid and showed that: i) high sodium intake may predispose to hazardous hyperkalemia after massive glucose loading in certain nondiabetic patients with liability to suppression of aldosterone; ii) sodium restriction abolishes the glucose-induced abnormal serum potassium response.
D000293:Adolescent; D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000097:blood*; D001786:Blood Glucose / Q000032:analysis; D004039:Diet, Sodium-Restricted; D005260:Female; D005947:Glucose / Q000008:administration & dosage; D005950:Glucose Solution, Hypertonic / Q000008:administration & dosage; D006801:Humans; D006947:Hyperkalemia / Q000139:chemically induced*; D006977:Hypertension, Renal / Q000097:blood; D007263:Infusions, Parenteral; D007328:Insulin / Q000097:blood; D008297:Male; D008875:Middle Aged; D011188:Potassium / Q000097:blood / Q000652:urine; D012083:Renin / Q000097:blood*; D012964:Sodium / Q000008:administration & dosage*
D001786:Blood Glucose; D005950:Glucose Solution, Hypertonic; D007328:Insulin; D000450:Aldosterone; D012964:Sodium; D012083:Renin; D005947:Glucose; D011188:Potassium