Plasma Angiotensin II Concentrations in Diabetic Ketoacidosis and in Hyperosmolar Non-ketotic Hyperglycemia

Overview

Journal Acta Diabetol Lat

Specialty Endocrinology

Date 1981 Apr 1

PMID 6787829

Citations 1

Authors

P A Sullivan

H Gonggrijp

M J Crowley

J B Ferriss

D J OSullivan

Affiliations

Soon will be listed here.

Abstract

Plasma angiotensin II concentrations were measured in 14 patients in diabetic ketoacidosis and in two patients with hyperosmolar non-ketotic hyperglycemia, before treatment and again when blood glucose control was restored. In the ketoacidosis group plasma angiotensin II before treatment was markedly raised in all patients with otherwise uncomplicated diabetes, but was within the normal range in some patients with long-term complications such as neuropathy, retinopathy and nephropathy. Mean angiotensin II before treatment was significantly higher in otherwise uncomplicated patients than in those with long-term complications. However, plasma angiotensin II decreased with improved control in all. Angiotensin II levels did not correlate with indices of rehydration such as changes in blood urea, packed cell volume and calculated changes in plasma volume. There was, however, a significant negative association between pre-treatment angiotensin II and pH. Two patients with hyperosmolar non-ketotic hyperglycemia were more dehydrated but less acidotic. Pre-treatment angiotensin II in each was well below the mean of the ketoacidosis group. These data are further evidence that the renin-angiotensin system may be imparied in diabetics with long-term complications. In addition, they suggest that factors other than fluid depletion are also important in activating the renin-angiotensin system in uncontrolled diabetes.

Citing Articles

Hyperaldosteronism in ketoacidosis and in poorly controlled non-ketotic diabetes.

Quigley C, Sullivan P, Gonggrijp H, Crowley M, Ferriss J, OSullivan D Ir J Med Sci. 1982; 151(5):135-9.

PMID: 6809687 DOI: 10.1007/BF02940163.

References

Mackay J, Hayakawa H, Watkins P . Cardiovascular effects of insulin: plasma volume changes in diabetics. Diabetologia. 1978; 15(6):453-7. DOI: 10.1007/BF02342869. View

Christlieb A, Kaldany A, DElia J . Plasma renin activity and hypertension in diabetes mellitus. Diabetes. 1976; 25(10):969-74. DOI: 10.2337/diab.25.10.969. View

VAN BEAUMONT W . Evaluation of hemoconcentration from hematocrit measurements. J Appl Physiol. 1972; 32(5):712-3. DOI: 10.1152/jappl.1972.32.5.712. View

Christensen N . Plasma catecholamines in long-term diabetics with and without neuropathy and in hypophysectomized subjects. J Clin Invest. 1972; 51(4):779-87. PMC: 302191. DOI: 10.1172/JCI106872. View

Gavras H, Ribeiro A, Gavras I, Brunner H . Reciprocal relation between renin dependency and sodium dependency in essential hypertension. N Engl J Med. 1976; 295(23):1278-83. DOI: 10.1056/NEJM197612022952302. View

Gavras H, Kremer D, Brown J, Gray B, Lever A, MACADAM R . Angiotensin- and norepinephrine-induced myocardial lesions: experimental and clinical studies in rabbits and man. Am Heart J. 1975; 89(3):321-32. DOI: 10.1016/0002-8703(75)90082-4. View

Kisch E, Dluhy R, Williams G . Regulation of renin release by calcium and ammonium ions in normal man. J Clin Endocrinol Metab. 1976; 43(6):1343-50. DOI: 10.1210/jcem-43-6-1343. View

Christlieb A, Assal J, Katsilambros N, Williams G, Kozak G, Suzuki T . Plasma renin activity and blood volume in uncontrolled diabetes. Ketoacidosis, a state of secondary aldosteronism. Diabetes. 1975; 24(2):190-3. DOI: 10.2337/diab.24.2.190. View

SCHALEKAMP M, Birkenhager W, Zaal G, Kolsters G . Haemodynamic characteristics of low-renin hypertension. Clin Sci Mol Med. 1977; 52(4):405-12. DOI: 10.1042/cs0520405. View

10.

Dusterdieck G, McElwee G . Estimation of angiotensin II concentration in human plasma by radioimmunoassay. Some applications to physiological and clinical states. Eur J Clin Invest. 1971; 2(1):32-8. DOI: 10.1111/j.1365-2362.1971.tb00565.x. View

11.

de Chatel R, Weidmann P, Flammer J, ZIEGLER W, Vetter W, REUBI F . Sodium, renin, aldosterone, catecholamines, and blood pressure in diabetes mellitus. Kidney Int. 1977; 12(6):412-21. DOI: 10.1038/ki.1977.132. View

12.

Gundersen H, Christensen N . Intravenous insulin causing loss of intravascular water and albumin and increased adrenergic nervous activity in diabetics. Diabetes. 1977; 26(6):551-7. DOI: 10.2337/diab.26.6.551. View

13.

Scott R, Espiner E, DONALD R, Livesey J . Hormonal responses during treatment of acute diabetic ketoacidosis with constant insulin infusions. Clin Endocrinol (Oxf). 1978; 9(5):463-74. DOI: 10.1111/j.1365-2265.1978.tb03586.x. View

14.

VAN BEAUMONT W, Greenleaf J, Juhos L . Disproportional changes in hematocrit, plasma volume, and proteins during exercise and bed rest. J Appl Physiol. 1972; 33(1):55-61. DOI: 10.1152/jappl.1972.33.1.55. View

15.

Parving H . Increased microvascular permeability to plasma proteins in short- and long-term juvenile diabetics. Diabetes. 1976; 25(2 SUPPL):884-9. View

16.

Christlieb A, Munichoodappa C, Braaten J . Decreased response of plasma renin activity to orthostasis in diabetic patients with orthostatic hypotension. Diabetes. 1974; 23(10):835-40. DOI: 10.2337/diab.23.10.835. View

17.

Waldhausl W, Kleinberger G, Korn A, Dudczak R, Nowotny P . Severe hyperglycemia: effects of rehydration on endocrine derangements and blood glucose concentration. Diabetes. 1979; 28(6):577-84. DOI: 10.2337/diab.28.6.577. View

18.

Swales J, Thurston H . Plasma renin and angiotensin II measurement in hypertensive and normal subjects: correlation of basal and stimulated states. J Clin Endocrinol Metab. 1977; 45(1):159-63. DOI: 10.1210/jcem-45-1-159. View

19.

Alberti K, Hockaday T, Turner R . Small doses of intramuscular insulin in the treatment of diabetic "coma". Lancet. 1973; 2(7828):515-22. DOI: 10.1016/s0140-6736(73)92346-5. View

20.

Ferriss J, Sullivan P, Gonggrijp H, Long A, OSullivan D . Hypertension, hyperkalaemia and abnormalities of the renin-angiotensin system in diabetes mellitus. Ir J Med Sci. 1979; 148 Suppl 2:17-27. DOI: 10.1007/BF02938136. View