Ishikawa S, Sakuma N, Fujisawa G, Tsuboi Y, Okada K, Saito T
Department of Medicine, Jichi Medical School, Tochigi, Japan.
Endocr J. 1994 Feb;41(1):37-43. doi: 10.1507/endocrj.41.37.
We studied the changes in serum sodium (Na) and potassium (K) levels in seventeen patients in diabetic ketoacidosis and nine patients in non-ketotic hyperosmolar coma, who had marked hyperglycemia (707.4 +/- 75.6 mg/dl, mean +/- SEM) and dehydration. The disorder characterized two types of alteration. The one group was hyponatremia with hyperkalemia in 17 patients in diabetic ketoacidosis (132.9 +/- 2.0 and 5.7 +/- 0.2 mEq/l), and 4 patients in non-ketotic hyperosmolar coma (125.8 +/- 4.3 and 5.2 +/- 0.5 mEq/l). The other was hypernatremia (162.5 +/- 1.8 mEq/l) with hypokalemia (3.4 +/- 0.2 mEq/l) in 5 patients in non-ketotic hyperosmolar coma. Intensive therapy with insulin and fluid administration improved the diabetic hyperglycemia and associated abnormalities. The vectors showing the normalization of serum Na and K levels was in quite opposite directions between the patients with hyponatremia with hyperkalemia and those with hypernatremia with hypokalemia. The amounts of loss of circulatory blood volume exceeded 20% in three groups of patients, a loss greater in the hypernatremic patients than in the hyponatremic ones. These results indicate that serious body water depletion produces hypernatremia instead of hyponatremia in patients in diabetic coma. The disorder may be caused by the altered distribution of electrolytes between the intra- and extra-cellular spaces.
我们研究了17例糖尿病酮症酸中毒患者和9例非酮症高渗性昏迷患者的血清钠（Na）和钾（K）水平变化，这些患者均有明显的高血糖（707.4±75.6mg/dl，均值±标准误）和脱水。该病症表现为两种类型的改变。一组是17例糖尿病酮症酸中毒患者（132.9±2.0和5.7±0.2mEq/L）和4例非酮症高渗性昏迷患者（125.8±4.3和5.2±0.5mEq/L）出现低钠血症伴高钾血症。另一组是5例非酮症高渗性昏迷患者出现高钠血症（162.5±1.8mEq/L）伴低钾血症（3.4±0.2mEq/L）。胰岛素强化治疗和补液改善了糖尿病高血糖及相关异常情况。低钠血症伴高钾血症患者和高钠血症伴低钾血症患者血清钠和钾水平恢复正常的向量方向完全相反。三组患者循环血容量损失均超过20%，高钠血症患者的损失大于低钠血症患者。这些结果表明，糖尿病昏迷患者严重的机体水分缺失导致的是高钠血症而非低钠血症。这种病症可能是由细胞内和细胞外间隙电解质分布改变引起的。
