OPPOSITE CHANGES IN SERUM SODIUM AND POTASSIUM IN PATIENTS IN DIABETIC COMA

We studied the changes in serum sodium (Na) and potassium (K) levels i n 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 ty pes 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 h ypokalemia (3.4+/-0.2 mEq/l) in 5 patients in non-ketotic hyperosmolar coma. Intensive therapy with insulin and fluid administration improve d the diabetic hyperglycemia and associated abnormalities. The vectors showing the normalization of serum Na and K levels was in quite oppos ite directions between the patients with hyponatremia with hyperkalemi a and those with hypernatremia with hypokalemia. The amounts of loss o f circulatory blood volume exceeded 20% in three groups of patients, a loss greater in the hypernatremic patients than in the hyponatremic o nes. These results indicate that serious body water depletion produces hypernatremia instead of hyponatremia in patients in diabetic coma. T he disorder may be caused by the altered distribution of electrolytes between the intra- and extra-cellular spaces.