Influence of Severe High Blood Glucose on Detection Value of Serum Sodium

CHEN Hua; LIU Xin; MENG Qing-yi

doi:10.3969/j.issn.1002-3429.2015.07.006

Abstract：Objective To summarize the experience of diagnosis and treatment about the blood glucose affecting de-tection value of serum sodium and to analyze the causes of misdiagnosis to prevent misdiagnosis and mistreatment. Methods The clinical data of 2 cases with abnormal serum sodium affected by severe blood glucose in our hospital were retrospectively analyzed with a review of related literature. Results The first case suffered from coma for 10 h during the infusion for the left toe injury with the initial diagnosis of septic shock, and the diabetic ketoacidosis coma was diagnosed after the laboratory study. The blood glucose was not reduced with the hypernatremia emerging after the large dose of supplementary saline and small dose of regular insulin were given. The sustaining high blood glucose due to the insulin resistance plus the secondary high blood sodium raised the blood osmotic pressure sharply. After large dose of insulin, the hypertonic condition was con-trolled. The second case suffered from a intermittent low fever for 2 months, and dyspnea with unconsciousness for 1 h. The laboratory examination showed severe high blood glucose and moderate hyponatremia, and asthma was considered with pulmo-nary embolism. After the pulmonary artery and coronary artery angiography check-up, no obvious abnormality was found, re-consultation was made and it was believed that the high blood sugar might cause low sodium, the actual plasma osmotic pres-sure of this patient might be increased, and the diagnosis of diabetic nektonic hyperosmolar state was considered. Then the pa-tient's condition improved markedly after the targeted treatment. Conclusion Severe abnormal blood glucose may have a sig-nificant impact on serum sodium, and improved awareness of its pathophysiological mechanisms has some important guiding significance for clinical diagnosis and treatment.