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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