Recognize Hyponatremia in Diabetic Ketoacidosis
Introduction
In managing diabetic ketoacidosis (DKA), accurate assessment of sodium is crucial. Hyperglycemia in DKA can cause pseudohyponatremia (sodium levels appear falsely low), leading to potential mismanagement if not properly corrected.
Managing Diabetic Ketoacidosis (DKA): Sodium Correction
Understanding Sodium and Hyperglycemia
High glucose levels draw water out of cells into the bloodstream, diluting sodium and causing hyperosmotic hyponatremia.
- Sodium drops by 2.4 mEq/L for every 100 mg/dL glucose rise.
- Correct sodium for glucose > 200 mg/dL using formula of Corrected Sodium (Hillier, 1999).
- Corrected Sodium = Measured Sodium + 0.024 × (Serum Glucose - 100).
- Or use MDCalc website, 🖱️ https://www.mdcalc.com/calc/50/sodium-correction-hyperglycemia.
Fluid Resuscitation Based on Corrected Sodium
Correct sodium levels are vital for guiding fluid resuscitation choices. For example, use 0.9% Normal Saline if corrected sodium is < 135 mEq/L, and switch to 0.45% Normal Saline if ≥ 135 mEq/L. This prevents cerebral edema and maintains electrolyte balance. Remember, when blood glucose drops to 200-250 mg/dL, change to D5 0.45% Normal Saline to prevent hypoglycemia and aid ketosis resolution.
Monitoring and Adjustment
Measure blood glucose and serum sodium on presentation. Use corrected sodium to guide fluid therapy, adjusting as glucose levels control. Reassess frequently to maintain balance and avoid complications.
Take-home points
- Measure blood glucose and serum sodium immediately upon patient presentation in DKA cases.
- Calculate corrected sodium using the formula: Corrected Sodium = Measured Sodium + 0.024 × (Serum Glucose - 100) for accurate assessment.
- Interpret sodium levels in conjunction with blood glucose to avoid treatment errors in DKA management.
- Use corrected sodium to guide the appropriate type of intravenous fluids.
- Monitor electrolytes and corrected sodium levels throughout DKA treatment for optimal patient outcomes.
References
- Chuang C, Guo YW, Chen HS. Corrected sodium levels for hyperglycemia is a better predictor than measured sodium levels for clinical outcomes among patients with extreme hyperglycemia. J Chin Med Assoc. 2020 Sep;83(9):845-851. doi: 10.1097/JCMA.0000000000000407
- Aziz F, Sam R, Lew SQ, Massie L, Misra M, Roumelioti ME, Argyropoulos CP, Ing TS, Tzamaloukas AH. Pseudohyponatremia: Mechanism, Diagnosis, Clinical Associations and Management. J Clin Med. 2023 Jun 15;12(12):4076. doi: 10.3390/jcm12124076
- Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN. Hyperglycemic crises in adult patients with diabetes. Diabetes Care. 2009;32(7):1335-1343. doi:10.2337/dc09-9032
- Besen BAMP, Ranzani OT, Singer M. Management of diabetic ketoacidosis. Intensive Care Med. 2023;49(1):95-98. doi:10.1007/s00134-022-06894-9
Keywords: Pseudohyponatremia due to hyperglycemia, Blood glucose and sodium levels, Corrected sodium calculation, Fluid resuscitation in DKA, Preventing cerebral edema in DKA, Maintaining electrolyte balance in DKA, Critical care pharmacy DKA guidelines, Accurate sodium assessment in DKA, Intravenous fluids for diabetic ketoacidosis, Continuous electrolyte monitoring in DKA, Effective DKA management strategies
Join the conversation