We studied the changes in serum
sodium (Na) and
potassium (K) levels in seventeen patients in
diabetic ketoacidosis and nine patients in non-ketotic hyperosmolar
coma, who had marked
hyperglycemia (707.4 +/- 75.6 mg/dl, mean +/- SEM) and
dehydration. The disorder characterized two types of alteration. The one group was
hyponatremia with
hyperkalemia in 17 patients in
diabetic ketoacidosis (132.9 +/- 2.0 and 5.7 +/- 0.2 mEq/l), and 4 patients in non-ketotic hyperosmolar
coma (125.8 +/- 4.3 and 5.2 +/- 0.5 mEq/l). The other was
hypernatremia (162.5 +/- 1.8 mEq/l) with
hypokalemia (3.4 +/- 0.2 mEq/l) in 5 patients in non-ketotic hyperosmolar
coma. Intensive
therapy with
insulin and fluid administration improved the diabetic
hyperglycemia and associated abnormalities. The vectors showing the normalization of serum Na and K levels was in quite opposite directions between the patients with
hyponatremia with
hyperkalemia and those with
hypernatremia with
hypokalemia. The amounts of loss of circulatory blood volume exceeded 20% in three groups of patients, a loss greater in the hypernatremic patients than in the hyponatremic ones. These results indicate that serious body water depletion produces
hypernatremia instead of
hyponatremia in patients in
diabetic coma. The disorder may be caused by the altered distribution of
electrolytes between the intra- and extra-cellular spaces.