| Body fluid abnormalities in severe hyperglycemia in patients on chronic dialysis: review of published reports. | |
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MedLine Citation:
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PMID: 18191075 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Reports of dialysis-associated hyperglycemia (DH) were compared to reports of diabetic ketoacidosis (DKA) and nonketotic hyperglycemia (NKH) in patients with preserved renal function. Average serum values in DH (491 observations), DKA (1036 observations), and NKH (403 observations) were as follows, respectively: glucose, 772, 649, and 961 mg/dl; sodium, 127, 134, and 149, mmol/l; and tonicity, 298, 304, and 355 mOsm/kg. Assuming that euglycemic (serum glucose, 90 mg/dl) values were the same (sodium, 140 mmol/l; tonicity, 285 mOsm/kg) for all three states, the hyperglycemic rise in the average serum tonicity value per 100-mg/dl rise in serum glucose concentration was 1.9 mOsm/kg in DH, 3.5 mOsm/kg in DKA, and 8.1 mOsm/kg in NKH. Neurological manifestations in DH patients were caused by coexisting conditions (ketoacidosis, sepsis, and neurological disease) in most instances, and by severe hypertonicity (>320 mOsm/kg), with clearing after insulin administration, in a few instances. In 148 episodes of DH corrected with insulin only, the mean increase in serum sodium per 100-mg/dl decrease in serum glucose (Delta[Na]/Delta[Glu]) was -1.61 mmol/l. In agreement with theoretical predictions, Delta[Na]/Delta[Glu] was numerically smaller in patients with edema than in those with euvolemia. The average hyperglycemic increase in extracellular volume, calculated from changes in serum sodium concentration during correction of DH using insulin alone, was 0.013 l/l per 100-mg/dl increase in serum glucose concentration. A small number of DH patients presented with pulmonary edema rectified by insulin alone. DH causes modest hypertonicity, with few patients having neurological manifestations caused usually by other coexisting conditions. In contrast to DKA or NKH, which usually presents with hypovolemia, DH causes hypervolemia manifested occasionally by pulmonary edema. Insulin is adequate treatment for DH. |
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Authors:
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Antonios H Tzamaloukas; Todd S Ing; Kostas C Siamopoulos; Mark Rohrscheib; Moses S Elisaf; Dominic S C Raj; Glen H Murata |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't; Review |
Journal Detail:
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Title: Journal of diabetes and its complications Volume: 22 ISSN: 1056-8727 ISO Abbreviation: J. Diabetes Complicat. Publication Date: 2008 Jan-Feb |
Date Detail:
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Created Date: 2008-01-14 Completed Date: 2008-03-04 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9204583 Medline TA: J Diabetes Complications Country: United States |
Other Details:
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Languages: eng Pagination: 29-37 Citation Subset: IM |
Affiliation:
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New Mexico VA Health Care System, Albuquerque, NM, USA. antonios.tzamaloukas@med.va.gov |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Blood Glucose Body Fluids / metabolism* Humans Hyperglycemia / drug therapy, etiology, metabolism* Insulin / therapeutic use Pulmonary Edema / etiology Renal Dialysis / adverse effects* Sodium / blood Water-Electrolyte Balance |
| Chemical | |
Reg. No./Substance:
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0/Blood Glucose; 11061-68-0/Insulin; 7440-23-5/Sodium |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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