Reversal of glucose-induced hyperkalemia by sodium restriction in "normaldosteronemic" diabetes mellitus.
The effects of intravenous infusion of hypertonic (0.5-1.0 g/kg) glucose on serum potassium was studied in three normokalemic control patients with essential hypertension (Group 1) and in four hyperkalemic patients with insulin-dependent diabetes during insulin withdrawal. Two of the diabetic patients with apparently normal plasma renin activity and aldosterone levels showed paradoxical "glucose-induced" hyperkalemia (group 2), while the other two diabetic patients with lower than normal plasma aldosterone levels (Group 3) did not. These findings suggested an individually different threshold level of mineralocorticoid for the normal regulation of potassium distribution between fluid compartments under which no protection from glucose-induced hyperkalemia could be expected. The concept was further supported by the findings obtained during sodium restriction associated with the dramatic increase in plasma aldosterone levels abolishing the paradoxical hyperkalemia induced by intravenous infusion of glucose. As the plasma aldosterone per serum potassium index was definitely low during intravenous glucose infusion in all diabetic patients while on high sodium intake, and in Group 3 even without infusion in recumbency, decreased adrenal sensitivity to potassium was postulated as a possible special form of selective hypoaldosteronism masked in some diabetic patients by "normal" plasma aldosterone levels.
D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D048909:Diabetes Complications; D004039:Diet, Sodium-Restricted; D005260:Female; D005947:Glucose; D006801:Humans; D006947:Hyperkalemia / Q000139:chemically induced* / Q000178:diet therapy / Q000209:etiology; D006973:Hypertension / Q000097:blood; D007328:Insulin / Q000097:blood; D008297:Male; D008875:Middle Aged; D011187:Posture; D012083:Renin / Q000097:blood; D012964:Sodium / Q000097:blood
D001786:Blood Glucose; D007328:Insulin; D000450:Aldosterone; D012964:Sodium; D012083:Renin; D005947:Glucose