Diabetic patients develop a constellation of electrolyte disorders.
These patients are markedly potassium-, magnesium- and phosphate-depleted.
The most important causal factor of chronic hyperkalemia in diabetic individuals is the syndrome of hyporeninemic hypoaldosteronism. Impaired renal function, potassium-sparing drugs, hypertonicity and insulin deficiency are also involved in the development of hyperkalemia.
Hyperglycemia increases serum osmolality, resulting in movement of water out of the cells and subsequently in a reduction of serum sodium levels ([Na+]) by dilution.
a correction factor by 2.4 mmol/L is used when serum glucose concentrations are higher than 400 mg/dL (22.2 mmol/L)
Principal causes of electrolyte disorders in diabetic patients
| Sodium disorders1 |
| Hyponatremia |
| Hyperglycemia (hypertonicity)-induced movement of water out of the cells (dilutional hyponatremia) |
| Osmotic diuresis-induced hypovolemic hyponatremia |
| Drug-induced hyponatremia: hypoglycemic agents (chlorpropamide, tolbutamide, insulin) or other medications (e.g., diuretics, amitriptyline) |
| Pseudonormonatremia (marked hyperlipidemia, severe hypoproteinemia) |
| Hypernatremia |
| Pseudohypernatremia (severe hypoproteinemia) |
| Loss of water in excess of sodium and potassium (osmotic dieresis), if this water loss is replaced insufficiently |
| Potassium disorders |
| Hypokalemia |
| Shift hypokalemia: insulin administration |
| Gastrointestinal loss of K+: malabsorption syndromes (diabetic-induced motility disorders, bacterial overgrowth, chronic diarrheal states) |
| Renal loss of K+: osmotic diuresis, hypomagnesemia, diuretics (thiazides, thiazide-like agents, furosemide) |
| Hyperkalemia |
| Shift hyperkalemia: acidosis, insulin deficiency, hypertonicity, rhabdomyolysis, drugs (e.g., beta blockers) |
| Reduced glomerular filtration of K+: acute and chronic kidney disease |
| Reduced tubular secretion of K+: hyporeninemic hypoaldosteronism, drugs (angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, renin inhibitors, beta blockers, potassium-sparing diuretics) |
| Magnesium disorders |
| Hypomagnesemia |
| Pseudohypomagnesemia: hypoalbuminemia |
| Shift hypomagnesemia: insulin administration |
| Poor dietary Mg2+ intake |
| Gastrointestinal Mg2+ losses: diarrhea as a result of diabetic autonomic neuropathy |
| Increased renal Mg2+ losses due to osmotic diuresis, glomerular hyperfiltration, diuretic administration |
| Recurrent metabolic acidosis |
| Calcium disorders |
| Hypocalcemia |
| Pseudohypοcalcemia: hypoalbuminemia2 |
| Hypomagnesemia |
| Vitamin D deficiency |
| Drug-mediated: loop diuretics |
| Hypercalcemia |
| Concurrent hyperparathyroidism |
| Thiazide therapy |
| Phosphorus disorders |
| Hypophosphatemia |
| Osmotic diuresis |
| Drugs: thiazides, loop diuretics, insulin |
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