Summary
PLASMA aldosterone concentrations were measured in 14 patients in diabetic ketoacidosis and in 20 patients with poorly controlled non-ketotic diabetes, both before treatment and again when metabolic control was achieved. Plasma aldosterone was above normal in 12 of 14 patients in ketoacidosis and there was a highly significant fall in mean plasma aldosterone concentration when metabolic control improved. Plasma aldosterone concentration in ketoacidosis was significantly related to plasma angiotensin //, arterial pH and indirect indices of dehydration. Plasma aldosterone was also above normal before treatment in 7 of 20 patients with poorly controlled non-ketotic diabetes. When metabolic control improved there was a small but significant reduction in mean plasma aldosterone concentration. However, plasma aldosterone and angiotensin were not significantly related in these patients.
It is concluded that ketoacidosis is usually associated with marked hyper-aldosteronism. Poorly controlled nonketotic diabetes is sometimes associated with mild aldosterone excess, which may contribute to the potassium wasting associated with poorly controlled diabetes.
Similar content being viewed by others
References
Christlieb, A. R., Assai, J., Katsilambros, N., Williams, G. H., Kozak, G. P. and Suzuki, T. 1975. Plasma renin activity and blood volume in uncontrolled diabetes: Ketoacidosis, a state of secondary aldosteronism. Diabetes 24, 190.
Dusterdieck, G., McElwee, G. 1971. Estimation of angiotensin // concentration in human plasma by radioimmunoassay. Some applications to physiological and clinical states. European J. Clin. Investigation 2, 32.
Ferriss, J. B Sullivan, P. A., Gonggrijp, H., Cole, M., O’Sullivan, D. J. 1981. Angiotensin // and aldosterone in unselected diabetics. Diabetologia 20, 669.
Fraser, R., Guest, S., Young, J. 1973. A comparison of double-isotope derivative and radioim- munological estimation of plasma aldosterone concentration in man. Clinical Science and Molecular Medicine 45, 411.
Perez, G. O., Oster, J. R., Katz, F. H., Vaamonde, C. A. 1979. The effect of acute metabolic acid- osis on plasma Cortisol, renin activity and aldosterone. Hormone Research 11, 12.
Schlichtkrull, J., Munck, O., Jersild, M. 1965. The M-value, an index of blood sugar control in diabetics. Acta Medica Scandinavica 177, 95.
Scott, R. S., Espiner, E. A., Donald, R. A., Livesey, J. H. 1978. Hormonal responses during treatment of acute diabetic ketoacidosis with constant insulin infusions. Clinical Endocrinology 9, 463.
Sullivan, P. A., Gonggrijp, H., Crowley, M. J., Ferriss, J. B., O’Sullivan, D. J. 1980. Plasma angiotensin and the control of diabetes mellitus. Clinical Endocrinology 13, 387.
Sullivan, P. A., Gonggrijp, H., Crowley, M. J., Ferriss, J. B. O’Sullivan, D. J. 1981. Plasma angiotensin II concentrations in diabetic ketoacidosis and in hyperosmolar non-ketotic hyper- glycaemia. Acta Diabetologica Latina 18, 139.
Van Beaumont, W. 1972. Evaluation of hemocon- centration from haematocrit measurements. J. Applied Physiol. 32, 712.
Waldhausl, W., Kleinberger, G., Korn, A., Dudczak, R., Bratusch-Marrain, P., Nowotny, P. 1979. Severe hyperglycemia: Effects of rehydration on endocrine derangements and blood glucose concentration Diabetes 28, 577.
Walsh, H., Soler, N. G., James, H., Fitzgerald, M. G., Malins, J. M. 1974, Studies on whole- body potassium in non-ketoacidotic diabetics before and after treatment. British Medical Journal 4, 738.
Zadik, Z., Kayne, R., Kappy, M., Plotnick, L. P., Kowarski, A. A. 1980. Increased integrated concentration of norepinephrine, epinephrine, aldosterone, and growth hormone in patients with uncontrolled juvenile diabetes mellitus. Diabetes 29, 655.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Quigley, C., Sullivan, P.A., Gonggrijp, H. et al. Hyperaldosteronism in ketoacidosis and in poorly controlled non-ketotic diabetes. Ir J Med Sci 151, 135–139 (1982). https://doi.org/10.1007/BF02940163
Issue Date:
DOI: https://doi.org/10.1007/BF02940163