Alteration of water balance and electrolytes in diabetics

A triple phenomenon occurs in the cell:

Cellular dehydration with passage of water to the extracellular compartment, due to
of hyprosmolarity determined by hyperglycemia.


 Protein catabolism, with less oncotic pressure, water and potassium outflow from the
cell and non-protein nitrogen increase.


 Malfunction of the sodium pump due to lower energy, shift Na / K,
migration of potassium to the extracellular compartment and sodium intake.

Alteration of water and electrolyte balance in diabetics

Simultaneously, as a consequence of the osmolar diuresis, a retraction occurs
of the extracellular compartment, with negative balance of water and electrolytes, especially
sodium and potassium It is difficult to establish the amount of the loss, since several authors have
employee for its determination the extent of the quantities necessary for the
replacement during therapy. The figures are variable.

IT is estimated that the loss of water is distributed in parts equal in the intracellular compartmends and extracellular.

The loss of water determines a decrease in blood volume, with a relative increase in
the amount of red blood cells and total proteins and increase in the hematocrit. As
Clinical consequence collapses and arterial hypotension occurs. Water losses
they are frequently accentuated by the vomiting with which diabetic acidosis begins.
There is an absolute loss of sodium, even from the reserve, located in the bones, with
great hypematruria as a consequence of osmolar diuresis. The natremia figures,
Although they are generally low, they do not accurately reflect sodium depletion,
be in a compartment with water loss.
The depletion of potassium acquires particular characteristics that must be considered in
the diagnosis and treatment. At the beginning, the loss is intracellular and, as a consequence,
there is an increase in potasemia, although an excretion is initiated
increased of this ion. Even in full diabetic coma, when oliguria or anuria

prevent glomerular filtration of potassium, potassium can be maintained high, normal or
slightly descended.
When the recovery of the patient begins by therapeutic action, when the
diuresis resumed potassium excretion, potassium re-enters the cell by
glucose intake and, finally, the extracellular potassium is diluted in a compartment
which has expanded by rehydration. This makes it the critical moment of the
hypokalemia

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