A diabetic patient with blood glucose of 600 mg/dL and Na 122 mEq/L was treated with insulin. After giving insulin the blood glucose decreased to 100 mg/dL. What changes in blood Na level is expected? (LQ)
|A||Increase in Na+ level|
|B||Decrease in Na+ level|
|C||No change would be expected|
|D||Na+ would return to previous level spontaneously on correction of blood glucose.|
Increase in Na + level
In diabetes pseudohyponatremia occurs i.e. the measured serum sodium is reduced as a consequence of the hyperglycemia.
1). There is a reduction of (1.6 meq) of serum sodium for each 100 mg/dL rise in the serum glucose.
2). A normal serum sodium in the setting of DKA indicates a more profound water deficit.
So when we treat a case of DKA, as the blood glucose level falls then measured serum sodium rises.
(Ref. Hari -18th ed., pg. 2978)
Causes of pseudohyponatremia:
1). Severe hyperglycemia (DKA, NKHOC)
3). Hyperproteinemia (Multiple myeloma)