The Corrected Serum Sodium Concentration in Hyperglycemic Crises: Computation and Clinical Applications

Frontiers in Medicine

article

Todd S. Ing¹  Kavitha Ganta²  Gautam Bhave³  Susie Q. Lew⁴  Emmanuel I. Agaba⁵  Christos Argyropoulos⁶  Antonios H. Tzamaloukas⁷ 

[1] Department of Medicine, Stritch School of Medicine, Loyola University Chicago, United States;Medicine Service, Department of Medicine, Raymond G. Murphy Veterans Affairs Medical Center, University of New Mexico School of Medicine, United States;Department of Medicine, Vanderbilt University Medical Center, United States;Department of Medicine, George Washington University School of Medicine, United States;Department of Medicine, University of Jos;Department of Medicine, University of New Mexico School of Medicine, United States;Research Service, Department of Medicine, Raymond G. Murphy Veterans Affairs Medical Center, University of New Mexico School of Medicine, United States

关键词: sodium concentration;    hyperglycemia;    dysnatremia;    hypertonicity;    diabetic ketoacidosis;    hyperosmolar hyperglycemia;   

DOI  :  10.3389/fmed.2020.00477

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

In hyperglycemia, hypertonicity results from solute (glucose) gain and loss of water in excess of sodium plus potassium through osmotic diuresis. Patients with stage 5 chronic kidney disease (CKD) and hyperglycemia have minimal or no osmotic diuresis; patients with preserved renal function and diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS) have often large osmotic diuresis. Hypertonicity from glucose gain is reversed with normalization of serum glucose ([Glu]); hypertonicity due to osmotic diuresis requires infusion of hypotonic solutions. Prediction of the serum sodium after [Glu] normalization (the corrected [Na]) estimates the part of hypertonicity caused by osmotic diuresis. Theoretical methods calculating the corrected [Na] and clinical reports allowing its calculation were reviewed. Corrected [Na] was computed separately in reports of DKA, HHS and hyperglycemia in CKD stage 5. The theoretical prediction of [Na] increase by 1.6 mmol/L per 5.6 mmol/L decrease in [Glu] in most clinical settings, except in extreme hyperglycemia or profound hypervolemia, was supported by studies of hyperglycemia in CKD stage 5 treated only with insulin. Mean corrected [Na] was 139.0 mmol/L in 772 hyperglycemic episodes in CKD stage 5 patients. In patients with preserved renal function, mean corrected [Na] was within the eunatremic range (141.1 mmol/L) in 7,812 DKA cases, and in the range of severe hypernatremia (160.8 mmol/L) in 755 cases of HHS. However, in DKA corrected [Na] was in the hypernatremic range in several reports and rose during treatment with adverse neurological consequences in other reports. The corrected [Na], computed as [Na] increase by 1.6 mmol/L per 5.6 mmol/L decrease in [Glu], provides a reasonable estimate of the degree of hypertonicity due to losses of hypotonic fluids through osmotic diuresis at presentation of DKH or HHS and should guide the tonicity of replacement solutions. However, the corrected [Na] may change during treatment because of ongoing fluid losses and should be monitored during treatment.

【 授权许可】

CC BY