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Diabetic ketoacidosis (DKA) is a metabolic emergency characterized by hyperglycemia, ketonemia, and metabolic acidosis. It results from severe insulin deficiency and an excess of counterregulatory hormones, leading to uncontrolled lipolysis, ketogenesis, and widespread electrolyte and fluid disturbances.Pathophysiology The central event in DKA is a profound loss of insulin action. Without insulin, glucose uptake in insulin-dependent tissues is impaired, while hepatic glucose production...
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DefinitionDiabetic ketoacidosis (DKA) is an acute, life-threatening complication of diabetes mellitus, characterized by a triad of hyperglycemia (blood glucose >250 mg/dL), ketonemia or ketonuria, and metabolic acidosis (arterial pH <7.30 and serum bicarbonate <18 mEq/L). It results from insulin deficiency combined with elevated levels of counterregulatory hormones—glucagon, catecholamines, cortisol, and growth hormone—leading to increased lipolysis, hepatic...
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Mannitol-induced Metabolic Alkalosis.

Kyung Pyo Kang1, Sik Lee1, Kyung Hoon Lee1

  • 1Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School, Chonbuk, Korea.

Electrolyte & Blood Pressure : E & BP
|January 25, 2014
PubMed
Summary

Intravenous infusion of mannitol, an osmotic diuretic, can cause metabolic alkalosis and hypokalemia. These acid-base and electrolyte changes occur regardless of the mannitol dose administered.

Keywords:
MannitolMetabolic alkalosis

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Area of Science:

  • Nephrology
  • Clinical Pharmacology
  • Internal Medicine

Background:

  • Mannitol is an osmotic diuretic agent used in various clinical settings.
  • Cerebral edema prevention is a key indication for mannitol administration.
  • Understanding mannitol's impact on acid-base and electrolyte balance is crucial for patient management.

Purpose of the Study:

  • To investigate the acid-base and electrolyte changes following intravenous infusion of hypertonic mannitol.
  • To determine if mannitol dosage influences the observed physiological effects.
  • To assess the potential for mannitol to induce metabolic alkalosis and hypokalemia.

Main Methods:

  • Three groups of study subjects received varying doses and infusion rates of 15% hypertonic mannitol.
  • Group A: 300-900 mL over 60-90 minutes.
  • Groups B and C received larger volumes over extended periods (12-24 hours and >24 hours, respectively).

Main Results:

  • All groups showed an increase in blood pH and plasma bicarbonate (HCO3(-)) levels, indicating metabolic alkalosis.
  • Plasma potassium (K+) levels decreased in all groups, indicating hypokalemia.
  • These effects were observed irrespective of the volume or infusion duration of mannitol.

Conclusions:

  • Intravenous infusion of hypertonic mannitol consistently induces metabolic alkalosis and hypokalemia.
  • The observed metabolic alkalosis may be attributed to increased renal bicarbonate production.
  • Clinical monitoring of acid-base and electrolyte balance is recommended during mannitol therapy.