Urinary prostaglandins in hyperglycaemic ketoacidosis of type I diabetes mellitus

Abstract

Urinary excretion of various renal prostaglandins was measured by radioimmunoassay and gas chromatography-mass spectrometry in children who had different degrees of metabolic control. Excretion in PGE₂ in diabetic children was twice control values irrespective of the presence or absence of diabetic ketoacidosis (DKA). The urinary excretion of PGF_2α was significantly increased in diabetic children with ketoacidosis, but not when diabetes was well controlled. The excretion of 13, 14 dihydro-15-keto PGE₂, the major metabolite of circulating PGE₂, was increased in all diabetic children, and was most elevated in ketoacidosis when it averaged 10 times basal excretion. Urinary excretion of PGI_2α and of 6-keto-PGF_1α, the metabolite of PGI₂, was approximately doubled in DKA compared with values from healthy subjects. Excretion of PGE₂ was twice control values in children with stable diatetes, whereas the equivalent value for TXB₂, the metabolite of the active vasoconstrictor TXA₂, was reduced by approximately 50%. We suggest that the increased excretion of prostacyclin metabolite may result from a protective biological action on the kidney opposing other vasoconstrictor hormone activity. PGE₂ appears not to be involved in this process. The highly elevated excretion of PGE₂ metabolite may represent an activation of systemic PGE metabolism during DKA.