Cooke C R, Horvath J S, Moore M A, Bledsoe T, Walker W G
J Clin Invest. 1973 Dec;52(12):3028-32. doi: 10.1172/JCI107501.
In studies on seven anephric patients, glucose and insulin administration before hemodialysis produced a significant reduction in plasma potassium concentration (mean reduction = 1.3, 1.7, and 1.4 meq/liter at 60, 120, and 180 min, respectively) which was accompanied by a significant and sustained reduction in plasma aldosterone concentration. There was a significant correlation between plasma aldosterone and plasma potassium concentration (r = +0.74, P < 0.001) and between changes in the concentration of plasma aldosterone occurring in individual patients and the corresponding changes in plasma potassium concentration (r = +0.52, P < 0.01). There was no significant change in plasma sodium concentration, and plasma corticoid concentration, which was monitored as an index of ACTH elaboration, was reduced at 60 min but increased subsequently as symptoms attributable to hypoglycemia were observed. These studies demonstrate that plasma aldosterone concentration can be modulated acutely by transitory changes in plasma potassium concentration without a change in potassium balance. The effect of glucose and insulin administration on intracellular potassium in the adrenal cortex is uncertain, and although increased net movement of potassium into cells is the presumptive mechanism of the reduction in plasma potassium concentration, whether the potassium content of the adrenal cortex may have increased or decreased or remained essentially unchanged, cannot be inferred from our data.
在对7名无肾患者的研究中，血液透析前给予葡萄糖和胰岛素可使血浆钾浓度显著降低（分别在60、120和180分钟时平均降低1.3、1.7和1.4毫当量/升），同时血浆醛固酮浓度也显著且持续降低。血浆醛固酮与血浆钾浓度之间存在显著相关性（r = +0.74，P < 0.001），个体患者血浆醛固酮浓度的变化与血浆钾浓度的相应变化之间也存在显著相关性（r = +0.52，P < 0.01）。血浆钠浓度无显著变化，作为促肾上腺皮质激素分泌指标监测的血浆皮质激素浓度在60分钟时降低，但随后随着低血糖症状的出现而升高。这些研究表明，血浆醛固酮浓度可通过血浆钾浓度的短暂变化而急性调节，而钾平衡无变化。葡萄糖和胰岛素给药对肾上腺皮质细胞内钾的影响尚不确定，虽然钾向细胞内净移动增加是血浆钾浓度降低的推测机制，但从我们的数据中无法推断肾上腺皮质的钾含量是增加、减少还是基本保持不变。
