Glucose-induced hyperkalemia in normaldosteronemic diabetes associated with hyperthyroidism

Infusion of hypertonic glucose induced "paradoxical" hyperkalemia in a 67-year old woman patient with normaldosteronemic diabetes mellitus associated with hyperthyroidism. Sodium restriction (10 mmol/day) abolished the glucose-induced paradoxical elevation of serum potassium by a dramatic increase in aldosterone production; a significant (P less than 0.01) inverse correlation was found between serum potassium and plasma aldosterone. Complete reversal of the abnormal serum potassium response occurred after successful antithyroid treatment suggesting that increased cellular aldosterone requirement may have been responsible for the paradoxical hyperkalemia during hyperthyroidism.