Hyperaldosteronism in ketoacidosis and in poorly controlled non-ketotic diabetes

PLASMA aldosterone concentrations were measured in 14 patients in diabetic ketoacidosis and in 20 patients with poorly controlled non-ketotic diabetes, both before treatment and again when metabolic control was achieved. Plasma aldosterone was above normal in 12 of 14 patients in ketoacidosis and there was a highly significant fall in mean plasma aldosterone concentration when metabolic control improved. Plasma aldosterone concentration in ketoacidosis was significantly related to plasma angiotensin //, arterial pH and indirect indices of dehydration. Plasma aldosterone was also above normal before treatment in 7 of 20 patients with poorly controlled non-ketotic diabetes. When metabolic control improved there was a small but significant reduction in mean plasma aldosterone concentration. However, plasma aldosterone and angiotensin were not significantly related in these patients. It is concluded that ketoacidosis is usually associated with marked hyper-aldosteronism. Poorly controlled nonketotic diabetes is sometimes associated with mild aldosterone excess, which may contribute to the potassium wasting associated with poorly controlled diabetes.