Editor
in Chief :
Mahmoud
Ashraf Ibrahim ,MD |
|
Issues
per Volume:
Quarterly
Current Volume: 1
Current Issue : 1
|
Volume
1 number 1 Summer 2003
Special issue for the abstracts of the 7th Pan Arab Conference
on Diabetes
PACD7 , 25 – 28 March 2003 Cairo
Abstract Number : 1
PERSISTENT A SYMPTOMATIC HYPEROSMOLALITY IN DIABETICS an early detector for hypertension
Dr/Almoutaz. A.Ahmed Saudi Arabia
Diabetes mellitus is one of metabolic disorder, which leads, in its uncontrollable form to different metabolic pathway disturbances. Disturbed carbohydrates will lead to hyperglycemic state. Disturbed lipid pathway leads to increase serum level of free fatty acids and glycerol. Disturbed protein pathway leads to increase serum level of free amino acids. Due to the hormonal pattern of diabetics and the effect of the stress hormones like Epinephrine and Nor-epinephrine, Growth hormone, Aldactone and Cortisol on the friable metabolic pathways, serum level of the previous substances will increase. Secondary to the effect of diabetes mellitus on kidneys, and the product of effects on electrolytes, which is controlled by Aldosterone hormone, and the fluid regulation done by the Anti-Diuretic Hormone (ADH) will start to disturb and the balance will favour increase osomlality. SsBy calculation serum osmolality is calculated as:
Serum osmolality = 2[sodium concentration in momEq/l+potassium concentration in momEq/l]+[glucose in mmol/l]+[blood urea nitrogen in moml/l]. All components of this equation are increased in diabetics. The antagonize systems [like the Atrial Natriureic Factor] are efficient enough to keep the serum osmolality between 285-295mosmol/kg, but when these systems start to fall (at specific time point in the life of diabetics, with individual variability) and persistent a symptomatic hyperosmolaity started to detected in the routine follow up of diabetics, the physician should be aware from the possibility of development of hypertension. Study was done in our clinic on 150 patients .50 patients were normo-tensive non-diabetics [control group] and 50 patients with diabetes [30 patients with diabetes type –2 and 20 patients with type-1] and 50 patients with diabetes and hypertension [30 patients’ type-2 with hypertension and 20 patients with type-1 and hypertension]. Factors like age, sex, life-style, duration of diabetes and drugs intake are considered. Serum hyperosmolality will leads to shift of extracellualr fluid to intravascular space and this will lead to plasma expansion and increases the cardiac out put, as a sequel of that, blood pressure will rise Blood pressure = Cardiac out put * Peripheral resistance So measurement of serum osmolality can direct the physician to hypertension in diabetics.
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