‘Contraction’ Alkalosis during Treatment of Hypergl Ycemia in CAPD Patients

Abstract

Two men on CAPD for renal failure from diabetic nephropathy developed three episodes of severe hyperglycemia (blood glucose greater than 50 mmol/l), which were treated with insulin alone. During treatment, the serum bicarbonate rose; in the first patient from 27 to 31 mmol/l; in the second patient from 24 to 31 in the first episode, and from 20 to 26 mmol/1 in the second episode. Corresponding changes in arterial pH were 7.47 to 7.57, 7.48 to 7.67 and 7.47 to 7.59. Contraction of the extracellular compartment during correction of hyperglycemia could account for the total increase in serum bicarbonate in the first patient, but only for about one-half of the increase in the second patient.