pituitrin and Diabetic-Coma

Topics: Adult; Blood Proteins; Diabetic Coma; Diuresis; Female; Humans; Hypertonic Solutions; Hyponatremia; Kidney Diseases; Lipids; Male; Mannitol; Middle Aged; Osmolar Concentration; Peritoneal Dialysis; Renal Dialysis; Sodium Chloride; Vasopressins; Water Intoxication

In order to clarify if vasopressin (VP) plays a role in the pathophysiology of hyperosmolar nonketotic diabetic coma (HNDC), VP has been infused to diabetic rats and plasma levels of glucose (PG), ketone bodies, FFA and glucagon were determined. High-dose VP infusion (1.2 U/kg/h) caused gradual elevation of PG (60%) and glucagon levels (600%), while ketone bodies showed transient decrease (20%) at 30 min. Under the suppression of endogenous glucagon secretion by constant infusion of somatostatin (100 micrograms/kg/h), high dose VP showed 25% increase in PG levels and 30% reduction of ketone body levels for the subsequent VP infusion for 1.5 hour. Low-dose VP infusion (0.06 U/kg/h) had no hyperglycemic effect, but suppressed ketosis (20%) in the same condition. There were no changes in plasma FFA concentrations, indicating no significant effect of VP on lipolysis. The results indicate that VP often elevated in HNDC may play an important role for the pathophysiology of HNDC through suppression of hepatic ketogenesis.

Topics: Animals; Blood Glucose; Diabetes Mellitus, Experimental; Diabetic Coma; Fatty Acids, Nonesterified; Glucagon; Glycerol; Insulin; Ketone Bodies; Ketosis; Male; Rats; Rats, Inbred Strains; Vasopressins

Hyperosmolar diabetic coma is characterised by extreme hyperglycaemia and dehydration. Hypernatremia often contributes additionally to plasma hyperosmolarity. The pathogenesis of these component abnormalities is considered. The explanation of the absence of hyperketonaemia is examined in the light of recent experimental and clinical data. At the beginning of the development of the syndrome, high peripheral plasma insulin probably explains the lack of ketosis via inhibition of lipolysis. Later, when hyperosmolar coma is established, peripheral insulinopenia but an "insulinised" liver may coexist. This would favour metabolism of free fatty acids along nonketogenic pathways.

Topics: Blood; Dehydration; Diabetic Coma; Glucagon; Humans; Hyperglycemia; Hyperglycemic Hyperosmolar Nonketotic Coma; Insulin; Kinetics; Osmolar Concentration; Sodium; Uremia; Vasopressins

Topics: Blood Glucose; Child; Child, Preschool; Craniopharyngioma; Diabetes Insipidus; Diabetic Coma; Female; Humans; Hyperglycemic Hyperosmolar Nonketotic Coma; Pituitary Neoplasms; Postoperative Complications; Vasopressins

In uncharacteristic clinical symptomatology the excess of water or the water intoxication render themselves conspicuous less by the signs of an increased fluid content than by central-nervous disturbances. Among the results of laboratory examinations the hypoosmolarity measured cryoscopically always, the hyponatraemia in most cases prove the excess of free water. Exceptions are discussed. A decreased capacity of the elimination of water pathogenetically plays a larger role than primarily excessive water supply. Apart from acute and chronic renal insufficiency the various forms of the Schwartz-Bartter-syndrome (inadequate ADH-secretion) play an increasingly more important role. The therapy demands the reduction of every supply of free water, the treatment of the evoking cause and only in cases of exception the administration of hypertonic saline solution, at the most dialysis treatment.

Topics: Diabetic Coma; Diagnosis, Differential; Humans; Kidney Diseases; Multiple Myeloma; Osmolar Concentration; Sodium; Vasopressins; Water Intoxication; Water-Electrolyte Balance

Topics: Autopsy; Blood Glucose; Blood Urea Nitrogen; Brain Diseases; Caudate Nucleus; Cerebral Cortex; Corpus Callosum; Creatinine; Demyelinating Diseases; Diabetic Coma; Female; Humans; Hypotension; Male; Metabolic Diseases; Middle Aged; Osmolar Concentration; Pons; Sodium; Vasopressins; Water-Electrolyte Balance

Topics: Adult; Blood Glucose; Dehydration; Diabetes Mellitus; Diabetic Coma; Diabetic Ketoacidosis; Diabetic Retinopathy; Glucose; Humans; Hyperglycemia; Hypothalamo-Hypophyseal System; Iatrogenic Disease; Insulin; Male; Pituitary Hormones, Anterior; Stress, Physiological; Vasopressins

Topics: Alcoholic Intoxication; Blood Glucose; Diabetic Coma; Ethanol; Humans; Mathematics; Osmolar Concentration; Polyuria; Thirst; Urea; Vasopressins