PMID: 2122740Nov 1, 1990Paper

Osmoregulation of vasopressin in diabetic ketoacidosis

The American Journal of Physiology
J A DurrC M Steinhart

Abstract

Osmoregulation of arginine vasopressin (AVP) is altered in diabetic ketoacidosis (DKA). With hyperglycemia, the AVP-plasma sodium (PNa) curve is displaced to the left, whereas the AVP-osmolality (Posm) curve is displaced to the right. The shift in the Na curve is explained by either resetting of the Na set point or by glucose acting as a nonpermeable solute, substituting for Na. Conversely, putative unmeasured solutes that, like urea, fail to affect AVP have been postulated to account for the right shift in the AVP-Posm curve. Therefore the respective roles of Posm = sigma [Xi] and plasma tonicity (Pton = sigma [sigmaiXi]), i.e., the sum of concentrations of all solutes [Xi] corrected (Pton) or not (Posm) for their relative cell permeability (sigma i), were studied in DKA. Indeed, Posm = sigma [Xi] exceeds Pton = sigma [sigma iXi] in DKA, since sigma i less than 1 for glucose. Potential determinants of AVP release (Posm, Pton, and PNa) were monitored in 7 patients with DKA. Conventional correlation analysis and two-dimensional (2D) graphs reproduced the paradox of an opposite shift in PNa and Posm set points for AVP release. However, by using the concept of tonicity instead of osmolality, 3D plots instead of 2D graphs, and mult...Continue Reading

References

May 1, 1979·Diabetes·R L ZerbeG L Robertson
Jul 1, 1976·Kidney International·G L RobertsonS Athar
Jul 1, 1988·The Journal of Pediatrics·G D HarrisL Finberg
Apr 23, 1987·The New England Journal of Medicine·J A DurrR W Schrier
Sep 1, 1970·The American Journal of Medicine·A Leaf
Jan 12, 1984·The New England Journal of Medicine·F J Gennari

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