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The osmotic link between hypoglycaemia and hypovolaemia
F Sjöstrand1, D Berndtson, J Olsson
1Research & Educational Centre Nackageriatriken, Lasarettsvägen 4, SE-13183 Nacka, Sweden. fredrik.sjostrand@ki.s
Scandinavian Journal of Clinical and Laboratory Investigation
|September 14, 2007
Summary
Hypoglycaemia (low blood sugar) and hypovolaemia (low blood volume) are linked after intravenous glucose infusions. This occurs due to fluid shifting into cells, causing dehydration despite kidney function.
Area of Science:
- Endocrinology
- Physiology
- Metabolism
Background:
- Hypoglycaemia (low blood sugar) is often observed alongside hypovolaemia (low blood volume).
- The underlying mechanism connecting these two conditions, particularly after glucose administration, requires elucidation.
Purpose of the Study:
- To investigate the relationship between intravenous glucose infusion and the development of rebound hypoglycaemia and hypovolaemia.
- To identify factors influencing the occurrence of these phenomena.
Main Methods:
- Analysis of data from 122 infusions of glucose solutions in 40 healthy volunteers and 40 patients.
- Measurement of plasma glucose, haemodilution (estimated via Hb changes), and glucose kinetics using a one-compartment model.
- Repeated measurements during and after infusions.
Main Results:
- A significant linear correlation (p<0.001) was observed between glucose levels and plasma volume expansion.
- Higher concentrations of infused glucose (>2.5%) increased the risk of hypoglycaemia and hypovolaemia in healthy individuals.
- Patients with insulin resistance (e.g., diabetics, surgical patients) experienced fewer and milder hypoglycaemic events.
Conclusions:
- Hypovolaemia is a direct consequence of hypoglycaemia following intravenous glucose infusion.
- The primary mechanism involves osmotic fluid shifts from extracellular to intracellular spaces, overriding renal compensation.
- This osmotic fluid shift explains the simultaneous occurrence of low blood sugar and low blood volume.
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