THE METABOLISM OF GLUCOSE AND ELECTROLYTES IN DIABETIC ACIDOSIS 1

Abstract

Seventeen cases of diabetic acidosis, studied during the early stages of the treatment of the disorder, received moderate or massive injns. of glucose. Utilization of carbohydrate occurred within the first 2-4 hrs. of treatment, since the injected glucose could not be completely recovered in the urine or extracellular fluid. Glycosuria swept out Na and Cl as well as water in large amts., and is probably the major cause of salt depletion and dehydration in diabetic acidosis. Evidence is presented suggesting that glucose is confined to the extracellular fluid. Hyperglycemia, therefore, draws water out of cells, producing cellular dehydration and diluting the serum Na and Cl. This is probably a major cause of low concns. of Na in the serum, and masks the magnitude of the total water deficit. Because of the deleterious consequences of hyper-tonicity and cellular dehydration, the importance of glucose soln. as a vehicle for the admn. of water without salt is stressed. Glycosuria resulting from injns. of exogenous glucose does not sweep K into the urine. The mechanism responsible for the initial elevation and subsequent depression of the serum K is discussed.