Prompt recovery of plasma arginine vasopressin in diabetic coma after intravenous infusion of a small dose of insulin and a large amount of fluid.
We studied the changes in plasma arginine vasopressin in 5 patients with diabetic ketoacidosis and one patient with non-ketotic hyperosmolar coma who had marked hyperglycemia (36.6 +/- 4.6 mmol/l, mean +/- SEM) and dehydration. Plasma osmolality (Posm) was 342.2 +/- 11.4 mOsm/kg H2O, and hematocrit, serum protein, and blood urea nitrogen were also elevated at hospitalization. Circulating blood volume was decreased by approximately 21% as compared with that on day 7. Plasma AVP level was increased to 8.5 +/- 1.6 pmol/l at hospitalization. When hyperglycemia was improved by iv infusion of a small dose of insulin plus fluid administration, plasma AVP level promptly decreased to 2.4 +/- 0.4 pmol/l within six hours. When plasma AVP level had normalized, Posm was still as high as 305 mOsm/kg H2O, but the loss of circulating blood volume was only 4.2% of the control state. Plasma AVP level was positively correlated with change in hematocrit (plasma AVP = 3.58 + 0.45.hematocrit, r = 0.468, p less than 0.01), serum protein (r = 0.487, p less than 0.01), Posm (r = 0.388, p less than 0.01), and blood glucose (r = 0.582, p less than 0.01). Plasma AVP level was negatively correlated with the change in circulating blood volume (plasma AVP = 3.6 - 0.14.change in circulating blood volume, r = -0.469, p less than 0.01). These results indicate that both non-osmotic and osmotic stimuli are involved in the mechanism for AVP release in patients with diabetic coma, and that the non-osmotic control of AVP may contribute to circulating homeostasis, protecting against severe blood volume depletion in diabetic patients suffering from hyperglycemia and dehydration.
Ishikawa
S
S
Department of Medicine, Jichi Medical School, Tochigi, Japan.
Saito
T
T
Okada
K
K
Nagasaka
S
S
Kuzuya
T
T
D000328:Adult; D000368:Aged; D001127:Arginine Vasopressin / Q000097:blood*; D003131:Combined Modality Therapy; D003681:Dehydration / Q000097:blood / Q000209:etiology / Q000628:therapy; D003926:Diabetic Coma / Q000097:blood* / Q000628:therapy*; D016883:Diabetic Ketoacidosis / Q000097:blood / Q000628:therapy; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D006944:Hyperglycemic Hyperosmolar Nonketotic Coma / Q000097:blood / Q000628:therapy; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged
D007328:Insulin; D001127:Arginine Vasopressin