Hyperkalemia in diabetes mellitus

Correspondence

Hyperkalemia in Diabetes Mellitus The concise and informative review on hyperkalemia in diabetes mellitus by Uribarri et al.’ covered most clinical states encountered in diabetic patients. One area that needs additional comments is hyperglycemia occurring in dialysis patients. The limited renal excretory capacity of dialysis patients should make them prone to severe hyperkalemia if they develop severe hyperglycemia. Indeed, hemodialysis patients with severe hyperglycemia often exhibit life-threatening hyperkalemia, whether they have metabolic acidosis or not;2.3 hyperkalemic deaths have been reported in such patients4.’ Patients on continuous ambulatory peritoneal dialysis with severe hyperglycemia do not usually develop hyperkalemia however.6.7 Such patients develop hyperkalemia only when severe hyperglycemia coexists with a second hyperkalemic

condition,

eg, rapid

tissue

destruction.3

The expla-

for the different kalemic responses to hyperglycemia between the two principal dialysis methods include continuous removal of the plasma potassium through the peritoneal dialysate in patients on continuous ambulatory peritoneal dialysis’ and the higher plasma mineralocorticoid levels that these patients usually exhibit in comparison to hemodialysis patients.’ The differences observed systematically in serum potassium concentration between hemodialysis patients and those on continuous ambulatory peritoneal dialysis’ need further investigation. Insulin administration alone usually constitutes sufficient treatment for both hyperglycemia and hyperkalemia in dialysis patients.3 Despite the relative simplicity of this treatment, serum potassium concentration should be monitored closely in dialysis patients with severe hyperglycemia. The presence of severe hyperkalemia in such patients dictates intensive care unit admission and electrocardiographic monitoring.3 In rare nations

offered

instances, particularly when serum potassium is low in hyperglycemia, administration of small amounts of potassium (IO-20 mmol) is necessary along with insulin administration. Antonios

H. Tzamaloukas, MD VA Medical Center Albuquerque, New Mexico

REFERENCES 1. Uribarri J, Oh MS, Carroll HJ: Hyperkalemia in diabetes mellitus. J Diabetic Complications 43-7, 1990. 2. Kaldany A, Curt GA, Estes NM, Weinraugh LA, Christlieb AR, D’Elid JA: Reversible acute pulmonary edema due to uncontrolled hyperglycemia in diabetic individuals with renal failure. Diabetes Care 5:506-511 11982. 3. Tzamaloukas AH, Avasthi PS: Serum potassium concentration in hyperglycemia of diabetes melhtus with long-term dialysis. West J Med 146:571-575, 1987.

4. Legrain M, Rottembourg J, Bentsikou A, Poignet JL, lssad B, Barthelemy A, Strippoli P, Gahl GM, De Groc F: Dialysis treatment of insulin-dependent diabetic patients: Ten years’ experience. C/in Nephro/21:72-81, 1984. 5. Montoliu J, Revert L: Lethal hyperkalemia with severe hyperglycemia in diabetic patients with renal failure. Am J Kidney Dis 5147-48. 1985. 6. Krediet RT, Stuijk DG, Arisz L: Hyponatremia in continuous ambulatory peritoneal dialysis patients with diabetic nephropathy during hyperglycemia episodes. Transplant Proc 28:1702-1704, 1986. 7. Tzamaloukas AH, Avasthi PS: Temporal profile of serum potassium concentration in nondiabetic and diabetic outpatients on chronic dialysis. Am J Nephro/7:101-109, 1987. of 18a. Zager PG, Frey JH, Gerdes BG: Plasma concentration hydroxycorticosterone and aldosterone in continuous ambulatory peritoneal dialysis and hemodialysis patients. Am J Kidney Dis3:313-318, 1983.

Dr. Uribarri replies: We agree with Dr. Tzamaloukas’ ciate his comments.

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