Abstract
Severe hyperkalemia (serum potassium level >6 mmol per liter [mEq per liter]), often with electrocardiographic disturbances, was noted at presentation in 30% of 73 hyperglycemic episodes (serum glucose concentration >25 mmol per liter [455 mg per dl]) observed in 15 in-hospital patients with insulin-dependent diabetes mellitus who were receiving long-term hemodialysis or peritoneal dialysis. Serum glucose concentration and total carbon dioxide content correlated significantly with the presenting serum potassium concentration. Treatment with parenteral insulin alone resulted in a decrease of the serum glucose value from 41 ± 14 (standard deviation) to 11 ± 5 mmol per liter (P <.001) and of serum potassium level from 5.2 ± 1.2 to 4.0 ± 0.6 mmol per liter (P <.001). The changes in serum glucose concentration and in carbon dioxide content and the serum potassium concentration at hyperglycemia were found to be independent correlates of the decrease in potassium concentration during treatment. Insulin alone resulted in correction of hyperkalemia in all instances. Posttreatment hypokalemia was noted in only two instances, each associated with both ketoacidosis and low-normal serum potassium concentration at hyperglycemia. Giving insulin is the only treatment usually needed for the hyperkalemia of hyperglycemia in patients on ongoing dialysis.
Full text
PDF




Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Adrogué H. J., Lederer E. D., Suki W. N., Eknoyan G. Determinants of plasma potassium levels in diabetic ketoacidosis. Medicine (Baltimore) 1986 May;65(3):163–172. doi: 10.1097/00005792-198605000-00004. [DOI] [PubMed] [Google Scholar]
- Adrogué H. J., Madias N. E. Changes in plasma potassium concentration during acute acid-base disturbances. Am J Med. 1981 Sep;71(3):456–467. doi: 10.1016/0002-9343(81)90182-0. [DOI] [PubMed] [Google Scholar]
- Al-Kudsi R. R., Daugirdas J. T., Ing T. S., Kheirbek A. O., Popli S., Hano J. E., Gandhi V. C. Extreme hyperglycemia in dialysis patients. Clin Nephrol. 1982 May;17(5):228–231. [PubMed] [Google Scholar]
- Ammon R. A., May W. S., Nightingale S. D. Glucose-induced hyperkalemia with normal aldosterone levels. Studies in a patient with diabetes mellitus. Ann Intern Med. 1978 Sep;89(3):349–351. doi: 10.7326/0003-4819-89-3-349. [DOI] [PubMed] [Google Scholar]
- Bia M. J., DeFronzo R. A. Extrarenal potassium homeostasis. Am J Physiol. 1981 Apr;240(4):F257–F268. doi: 10.1152/ajprenal.1981.240.4.F257. [DOI] [PubMed] [Google Scholar]
- Boyer J., Gill G. N., Epstein F. H. Hyperglycemia and hyperosmolality complicating peritoneal dialysis. Ann Intern Med. 1967 Sep;67(3):568–572. doi: 10.7326/0003-4819-67-3-568. [DOI] [PubMed] [Google Scholar]
- DeFronzo R. A., Sherwin R. S., Felig P., Bia M. Nonuremic diabetic hyperkalemia. Possible role of insulin deficiency. Arch Intern Med. 1977 Jul;137(7):842–843. doi: 10.1001/archinte.137.7.842. [DOI] [PubMed] [Google Scholar]
- Foster D. W. Insulin deficiency and hyperosmolar coma. Adv Intern Med. 1974;19:159–173. [PubMed] [Google Scholar]
- Fraley D. S., Adler S. Correction of hyperkalemia by bicarbonate despite constant blood pH. Kidney Int. 1977 Nov;12(5):354–360. doi: 10.1038/ki.1977.122. [DOI] [PubMed] [Google Scholar]
- Gault M. H., Ferguson E. L., Sidhu J. S., Corbin R. P. Fluid and electrolyte complications of peritoneal dialysis. Choice of dialysis solutions. Ann Intern Med. 1971 Aug;75(2):253–262. doi: 10.7326/0003-4819-75-2-253. [DOI] [PubMed] [Google Scholar]
- Goldfarb S., Cox M., Singer I., Goldberg M. Acute hyperkalemia induced by hyperglycemia: hormonal mechanisms. Ann Intern Med. 1976 Apr;84(4):426–432. doi: 10.7326/0003-4819-84-4-426. [DOI] [PubMed] [Google Scholar]
- Handa S. P., Cushner G. B. Hyperosmolar hyperglycemic nonketotic coma during peritoneal dialysis. South Med J. 1968 Jul;61(7):700–702. doi: 10.1097/00007611-196807000-00008. [DOI] [PubMed] [Google Scholar]
- Kaldany A., Curt G. A., Estes N. M., Weinrauch L. A., Christlieb A. R., D'Elia J. A. Reversible acute pulmonary edema due to uncontrolled hyperglycemia in diabetic individuals with renal failure. Diabetes Care. 1982 Sep-Oct;5(5):506–511. doi: 10.2337/diacare.5.5.506. [DOI] [PubMed] [Google Scholar]
- Legrain M., Rottembourg J., Bentchikou A., Poignet J. L., Issad B., Barthelemy A., Strippoli P., Gahl G. M., de Groc F. Dialysis treatment of insulin dependent diabetic patients: ten years experience. Clin Nephrol. 1984 Jan;21(1):72–81. [PubMed] [Google Scholar]
- Makoff D. L., Da Silva J. A., Rosenbaum B. J. On the mechanism of hyperkalaemia due to hyperosmotic expansion with saline or mannitol. Clin Sci. 1971 Nov;41(5):383–393. doi: 10.1042/cs0410383. [DOI] [PubMed] [Google Scholar]
- McCurdy D. K. Hyperosmolar hyperglycemic nonketotic diabetic coma. Med Clin North Am. 1970 May;54(3):683–699. [PubMed] [Google Scholar]
- McNair P., Madsbad S., Christiansen C., Christensen M. S., Transbøl I. Hyponatremia and hyperkalemia in relation to hyperglycemia in insulin-treated diabetic out-patients. Clin Chim Acta. 1982 Apr 8;120(2):243–250. doi: 10.1016/0009-8981(82)90161-9. [DOI] [PubMed] [Google Scholar]
- Montoliu J., Revert L. Lethal hyperkalemia associated with severe hyperglycemia in diabetic patients with renal failure. Am J Kidney Dis. 1985 Jan;5(1):47–48. doi: 10.1016/s0272-6386(85)80135-9. [DOI] [PubMed] [Google Scholar]
- Moreno M., Murphy C., Goldsmith C. Increase in serum potassium resulting from the administration of hypertonic mannitol and other solutions. J Lab Clin Med. 1969 Feb;73(2):291–298. [PubMed] [Google Scholar]
- Nicolis G. L., Kahn T., Sanchez A., Gabrilove J. L. Glucose-induced hyperkalemia in diabetic subjects. Arch Intern Med. 1981 Jan;141(1):49–53. [PubMed] [Google Scholar]
- Perez G. O., Lespier L., Knowles R., Oster J. R., Vaamonde C. A. Potassium homeostasis in chronic diabetes mellitus. Arch Intern Med. 1977 Aug;137(8):1018–1022. [PubMed] [Google Scholar]
- Popp D., Achtenberg J. F., Cryer P. E. Hyperkalemia and hyperglycemic increments in plasma potassium in diabetes mellitus. Arch Intern Med. 1980 Dec;140(12):1617–1621. [PubMed] [Google Scholar]
- Potter D. J. Death as a result of hyperglycemia without ketosis--a complication of hemodialysis. Ann Intern Med. 1966 Feb;64(2):399–401. doi: 10.7326/0003-4819-64-2-399. [DOI] [PubMed] [Google Scholar]
- Rosenbaum R., Hoffsten P. E., Cryer P., Klahr S. Hyperkalemia after renal transplantation. Occurrence in a patient with insulin-dependent diabetes. Arch Intern Med. 1978 Aug;138(8):1270–1272. doi: 10.1001/archinte.138.8.1270. [DOI] [PubMed] [Google Scholar]
- Rosenstock J., Loizou S. A., Brajkovich I. E., Mashiter K., Joplin G. F. Effect of acute hyperglycaemia on plasma potassium and aldosterone levels in type 2 (non-insulin-dependent) diabetes. Diabetologia. 1982 Mar;22(3):184–187. doi: 10.1007/BF00283750. [DOI] [PubMed] [Google Scholar]
- Sterns R. H., Cox M., Feig P. U., Singer I. Internal potassium balance and the control of the plasma potassium concentration. Medicine (Baltimore) 1981 Sep;60(5):339–354. doi: 10.1097/00005792-198109000-00002. [DOI] [PubMed] [Google Scholar]
- Sterns R. H., Feig P. U., Pring M., Guzzo J., Singer I. Disposition of intravenous potassium in anuric man: a kinetic analysis. Kidney Int. 1979 Jun;15(6):651–660. doi: 10.1038/ki.1979.85. [DOI] [PubMed] [Google Scholar]
- Tzamaloukas A. H., Avasthi P. S. Effect of hyperglycemia on serum sodium concentration and tonicity in outpatients on chronic dialysis. Am J Kidney Dis. 1986 Jun;7(6):477–482. doi: 10.1016/s0272-6386(86)80188-3. [DOI] [PubMed] [Google Scholar]
- Tzamaloukas A. H., Gardner K. D., Jr Plasma potassium changes in anuric hyperglycemia treated with insulin. Am J Med Sci. 1984 Jan-Feb;287(1):27–30. doi: 10.1097/00000441-198401000-00006. [DOI] [PubMed] [Google Scholar]
- Tzamaloukas A. H., Levinstone A. R., Gardner K. D., Jr Hyperglycemia in advanced renal failure: sodium and water metabolism. Nephron. 1982;31(1):40–44. doi: 10.1159/000182612. [DOI] [PubMed] [Google Scholar]
- Viberti G. C. Glucose-induced hyperkalaemia: A hazard for diabetics? Lancet. 1978 Apr 1;1(8066):690–691. doi: 10.1016/s0140-6736(78)90801-2. [DOI] [PubMed] [Google Scholar]
- WOLF A. V., McDOWELL M. E. Apparent and osmotic volumes of distribution of sodium, chloride, sulfate and urea. Am J Physiol. 1954 Feb;176(2):207–212. doi: 10.1152/ajplegacy.1954.176.2.207. [DOI] [PubMed] [Google Scholar]
- ZIERLER K. L. Effect of insulin on potassium efflux from rat muscle in the presence and absence of glucose. Am J Physiol. 1960 May;198:1066–1070. doi: 10.1152/ajplegacy.1960.198.5.1066. [DOI] [PubMed] [Google Scholar]
