Yijuan Sun1,2, Maria-Eleni Roumelioti2, Kavitha Ganta1,2, Robert H Glew3, James Gibb2, Darlene Vigil1,2, Catherine Do1,2,4, Karen S Servilla1,2,5, Brent Wagner1,2,4,5, Jonathan Owen2, Mark Rohrscheib2, Richard I Dorin6, Glen H Murata7, Antonios H Tzamaloukas8,9,10. 1. Renal Section, Medicine Service, Raymond G. Murphy Veterans Affairs Medical Center, 1501 San Pedro, SE, Albuquerque, NM, 87108, USA. 2. Division of Nephrology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA. 3. Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM, USA. 4. Kidney Institute of New Mexico, Albuquerque, NM, USA. 5. Research Service, Raymond G. Murphy Veterans Affairs Medical Center, Albuquerque, NM, USA. 6. Endocrinology Section, Raymond G. Murphy Veterans Affairs Medical Section, and Division of Endocrinology, University of New Mexico School of Medicine, Albuquerque, NM, USA. 7. Physician, Raymond G. Murphy Veterans Affairs Medical Center, Albuquerque, NM, USA. 8. Renal Section, Medicine Service, Raymond G. Murphy Veterans Affairs Medical Center, 1501 San Pedro, SE, Albuquerque, NM, 87108, USA. Antonios.Tzamaloukas@va.gov. 9. Division of Nephrology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA. Antonios.Tzamaloukas@va.gov. 10. Research Service, Raymond G. Murphy Veterans Affairs Medical Center, Albuquerque, NM, USA. Antonios.Tzamaloukas@va.gov.
Abstract
PURPOSE: Dialysis-associated hyperglycemia (DAH), is associated with a distinct fluid and electrolyte pathophysiology. The purpose of this report was to review the pathophysiology and provide treatment guidelines for DAH. METHODS: Review of published reports on DAH. Synthesis of guidelines based on these reports. RESULTS: The following fluid and solute abnormalities have been identified in DAH: (a) hypoglycemia: this is a frequent complication of insulin treatment and its prevention requires special attention. (b) Elevated serum tonicity. The degree of hypertonicity in DAH is lower than in similar levels of hyperglycemia in patients with preserved renal function. Typically, correction of hyperglycemia with insulin corrects the hypertonicity of DAH. (c) Extracellular volume abnormalities ranging from pulmonary edema associated with osmotic fluid shift from the intracellular into the extracellular compartment as a consequence of gain in extracellular solute (glucose) to hypovolemia from osmotic diuresis in patients with residual renal function or from fluid losses through extrarenal routes. Correction of DAH by insulin infusion reverses the osmotic fluid transfer between the intracellular and extracellular compartments and corrects the pulmonary edema, but can worsen the manifestations of hypovolemia, which require saline infusion. (d) A variety of acid-base disorders including ketoacidosis correctable with insulin infusion and no other interventions. (e) Hyperkalemia, which is frequent in DAH and is more severe when ketoacidosis is also present. Insulin infusion corrects the hyperkalemia. Extreme hyperkalemia at presentation or hypokalemia developing during insulin infusion require additional measures. CONCLUSIONS: In DAH, insulin infusion is the primary management strategy and corrects the fluid and electrolyte abnormalities. Patients treated for DAH should be monitored for the development of hypoglycemia or fluid and electrolyte abnormalities that may require additional treatments.
PURPOSE: Dialysis-associated hyperglycemia (DAH), is associated with a distinct fluid and electrolyte pathophysiology. The purpose of this report was to review the pathophysiology and provide treatment guidelines for DAH. METHODS: Review of published reports on DAH. Synthesis of guidelines based on these reports. RESULTS: The following fluid and solute abnormalities have been identified in DAH: (a) hypoglycemia: this is a frequent complication of insulin treatment and its prevention requires special attention. (b) Elevated serum tonicity. The degree of hypertonicity in DAH is lower than in similar levels of hyperglycemia in patients with preserved renal function. Typically, correction of hyperglycemia with insulin corrects the hypertonicity of DAH. (c) Extracellular volume abnormalities ranging from pulmonary edema associated with osmotic fluid shift from the intracellular into the extracellular compartment as a consequence of gain in extracellular solute (glucose) to hypovolemia from osmotic diuresis in patients with residual renal function or from fluid losses through extrarenal routes. Correction of DAH by insulin infusion reverses the osmotic fluid transfer between the intracellular and extracellular compartments and corrects the pulmonary edema, but can worsen the manifestations of hypovolemia, which require saline infusion. (d) A variety of acid-base disorders including ketoacidosis correctable with insulin infusion and no other interventions. (e) Hyperkalemia, which is frequent in DAH and is more severe when ketoacidosis is also present. Insulin infusion corrects the hyperkalemia. Extreme hyperkalemia at presentation or hypokalemia developing during insulin infusion require additional measures. CONCLUSIONS: In DAH, insulin infusion is the primary management strategy and corrects the fluid and electrolyte abnormalities. Patients treated for DAH should be monitored for the development of hypoglycemia or fluid and electrolyte abnormalities that may require additional treatments.
Authors: Antonios H Tzamaloukas; Todd S Ing; Kostas C Siamopoulos; Dominic S C Raj; Moses S Elisaf; Mark Rohrscheib; Glen H Murata Journal: Semin Dial Date: 2008 Sep-Oct Impact factor: 3.455
Authors: Nikifor K Konstantinov; Mark Rohrscheib; Emmanuel I Agaba; Richard I Dorin; Glen H Murata; Antonios H Tzamaloukas Journal: World J Diabetes Date: 2015-07-25
Authors: Helbert Rondon-Berrios; Christos Argyropoulos; Todd S Ing; Dominic S Raj; Deepak Malhotra; Emmanuel I Agaba; Mark Rohrscheib; Zeid J Khitan; Glen H Murata; Joseph I Shapiro; Antonios H Tzamaloukas Journal: World J Nephrol Date: 2017-01-06
Authors: Todd S Ing; Kavitha Ganta; Gautam Bhave; Susie Q Lew; Emmanuel I Agaba; Christos Argyropoulos; Antonios H Tzamaloukas Journal: Front Med (Lausanne) Date: 2020-08-25