Abstract
Alterations in electrolyte balance have been claimed to play a role in the pathophysiology
of coronary heart disease; however, the relationship between the electrolyte pattern
and other clinical variables immediately after an acute vascular event is unclear.
The aim of the present study was to test whether electrolyte and microelement changes
characterize the acute phase in patients with different degrees of glucose tolerance
admitted to the hospital shortly after an acute cardiovascular or cerebrovascular
ischemic event. Two hundred consecutive patients with either myocardial infarction
or stroke (SP group), stratified by degree of glucose tolerance, were studied within
six hours of admission, and compared against 125 patients admitted for conditions
other than acute vascular ischemia (CP). Routine laboratory parameters and serum Na,
K, Cl, Mg and Ca concentrations were determined in all patients and compared to those
recorded within six months before the admission. Relative to CP and independently
of confounding factors including glucose tolerance status, the SP group showed significantly
higher plasma glucose and insulin concentrations, higher creatinine and a modified
serum electrolyte pattern characterized by significantly lower potassium and magnesium
levels and by hypercalcemia and hyperphosphatemia. Irrespective of glucose tolerance,
the first hours following an acute vascular event are characterized by marked insulin
resistance with a consistent shift in the serum electrolyte pattern. This pattern
is the physiological consequence of the attendant compensatory hyperinsulinemia. Its
significance for the evolution of ischemic damage remains to be established.
Key words
Myocardial infarction - stroke - electrolytes - insulin - kidney function
References
- 1
Resnick L.
The cellular ionic basis of hypertension and allied clinical conditions.
Prog Cardiovasc Dis.
1999;
42
1-22
- 2
Cain A E, Khalil R A.
Pathophysiology of essential hypertension: role of the pump, the vessel, and the kidney.
Semin Nephrol.
2002;
22
3-16
- 3
Johan Groeneveld A B, Beishuizen A, Visser F C.
Insulin: a wonder drug in the critically ill?.
Crit Care.
2002;
6
102-105
- 4
Green D M, Ropper A H, Kronmal R A, Psaty B M, Burke G L.
Cardiovascular Health Study. Serum potassium level and dietary potassium intake as
risk factors for stroke.
Neurology.
2002;
59
314-320
- 5
Smith N L, Lemaitre R N, Heckbert S R, Kaplan R C, Tirschwell D L, Longstreth W T,
Psaty B M.
Serum potassium and stroke risk among treated hypertensive adults.
Am J Hypertens.
2003;
16
806-813
- 6
Djurhuus M S, Klitgaard N A, Pedersen K K, Blaabjerg O, Altura B M, Altura B T, Henriksen J E.
Magnesium reduces insulin-stimulated glucose uptake and serum lipid concentrations
in type 1 diabetes.
Metabolism.
2001;
50
1409-1417
- 7
Maier J A.
Low magnesium and atherosclerosis: an evidence-based link.
Mol Aspects Med.
2003;
24
137-146
- 8
Liao F, Folsom A R, Brancati F L.
Is low magnesium concentration a risk factor for coronary heart disease? The Atherosclerosis
Risk in Communities (ARIC) Study.
Am Heart J.
1998;
136
480-490
- 9
Igawa A, Miwa K, Miyagi Y, Fujita M, Inoue H.
Comparison of frequency of magnesium deficiency in patients with vasospastic angina
and fixed coronary artery disease.
Am J Cardiol.
1995;
75
728-731
- 10
Kao W H, Folsom A R, Nieto F J, Mo J P, Watson R L, Brancati F L.
Serum and dietary magnesium and the risk for type 2 diabetes mellitus: the Atherosclerosis
Risk in Communities Study.
Arch Intern Med.
1999;
159
2151-2159
- 11
Whang R, Sims G.
Magnesium and potassium supplementation in the prevention of diabetic vascular disease.
Med Hypotheses.
2000;
55
263-265
- 12
Kautzky-Willer A, Pacini G, Niederle B, Schernthaner G, Prager R.
Insulin secretion, insulin sensitivity and hepatic insulin extraction in primary hyperparathyroidism
before and after surgery.
Clin Endocrinol.
1992;
37
147-155
- 13
DeFronzo R A, Lang R.
Hypophosphatemia and glucose intolerance: evidence for tissue insensitivity to insulin.
N Engl J Med.
1980;
303
1259-1263
- 14
Ognibene A, Ciniglio R, Greifenstein A, Jarjoura D, Cugino A, Blend D, Whittier F.
Ventricular tachycardia in acute myocardial infarction: the role of hypophosphatemia.
South Med J.
1994;
87
65-69
- 15
Kaplan R C, Heckbert S R, Furberg C D, Psaty B M.
Predictors of subsequent coronary events, stroke, and death among survivors of first
hospitalized myocardial infarction.
J Clin Epidemiol.
2002;
55
654-664
- 16
MacWalter R S, Wong S Y, Wong K Y, Stewart G, Fraser C G, Fraser H W, Ersoy Y, Ogston S A,
Chen R.
Does renal dysfunction predict mortality after acute stroke? A 7-year follow-up study.
Stroke.
2002;
33
1630-1635
- 17
Brandi L S, Santoro D, Natali A, Altomonte F, Baldi S, Frascerra S, Ferrannini E.
Insulin resistance of stress: sites and mechanisms.
Clin Sci.
1993;
85
525-535
- 18
Seematter G, Binnert C, Martin J L, Tappy L.
Relationship between stress, inflammation and metabolism.
Curr Opin Clin Nutr Metab Care.
2004;
7
169-173
- 19
Gao F, Gao E, Yue T L, Ohlstein E H, Lopez B L, Christopher T A, Ma X L.
Nitric oxide mediates the antiapoptotic effect of insulin in myocardial ischemia-reperfusion:
the roles of PI3-kinase, Akt, and endothelial nitric oxide synthase phosphorylation.
Circulation.
2002;
105
1497-1502
- 20
Sundell J, Nuutila P, Laine H, Luotolahti M, Kalliokoski K, Raitakari O, Knuuti J.
Dose-dependent vasodilating effects of insulin on adenosine-stimulated myocardial
blood flow.
Diabetes.
2002;
51
1125-1130
- 21
van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D,
Ferdinande P, Lauwers P, Bouillon R.
Intensive insulin therapy in the critically ill patients.
N Engl J Med.
2001;
345
1359-1367
- 22
DeFronzo R A, Bia M, Birkhead G.
Epinephrine and potassium homeostasis.
Kidney Int.
1981;
20
83-91
- 23
Natali A, Quinones Galvan A, Santoro D, Pecori N, Taddei S, Salvetti A, Ferrannini E.
Relationship between insulin release, antinatriuresis and hypokalaemia after glucose
ingestion in normal and hypertensive man.
Clin Sci.
1993;
85
327-335
- 24
Muscelli E, Natali A, Bianchi S, Bigazzi R, Galvan A Q, Sironi A M, Frascerra S, Ciociaro D,
Ferrannini E.
Effect of insulin on renal sodium and uric acid handling in essential hypertension.
Am J Hypertens.
1996;
9
746-752
- 25
Sodi-Pallares D, Bisteni A, Medrano G A, Cisneros F, Ponce de Leon J.
The polarizing treatment for myocardial infarction.
Am J Cardiol.
1969;
24
607-608
- 26
Izumi Y, Roussel S, Pinard E, Seylaz J.
Reduction of infarct volume by magnesium after middle cerebral artery occlusion in
rats.
J Cereb Blood Flow Metab.
1991;
11
1025-1030
- 27
Matsusaka T, Hasebe N, Jin Y T, Kawabe J, Kikuchi K.
Magnesium reduces myocardial infarct size via enhancement of adenosine mechanism in
rabbits.
Cardiovasc Res.
2002;
54
568-575
- 28
Tsuji H, Venditti F J Jr, Evans J C, Larson M G, Levy D.
The associations of levels of serum potassium and magnesium with ventricular premature
complexes (the Framingham Heart Study).
Am J Cardiol.
1994;
74
232-235
- 29
Lind L, Skarfors E, Berglund L, Lithell H, Ljunghall S.
Serum calcium: a new, independent, prospective risk factor for myocardial infarction
in middle-aged men followed for 18 years.
J Clin Epidemiol.
1997;
50
967-973
- 30
Hvarfner A, Larsson R, Morlin C, Rastad J, Wide L, Akerstrom G, Ljunghall S.
Cytosolic free calcium in platelets-relationships to blood pressure and indices of
systemic calcium metabolism.
J Hypertens.
1988;
6
71-77
- 31
Schaefer W, Priessen J, Mannhold R, Gries A F.
Ca2+-Mg2+ ATPase activity of human red blood cells in healthy and diabetic volunteers.
Klin Wochenschr.
1987;
65
17-21
- 32
Quinones Galvan A, Natali A, Baldi S, Frascerra S, Sanna G, Ciociaro D, Ferrannini E.
Effect of insulin on uric acid excretion in humans.
Am J Physiol.
1995;
268
E1-E5
- 33
Yu Z F, Bruce-Keller A J, Goodman Y, Mattson M P.
Uric acid protects neurons against excitotoxic and metabolic insults in cell culture
and against focal ischemic brain injury in vivo.
J Neurosci Res.
1998;
53
613-625
- 34
Chamorro A, Obach V, Cervera A, Revilla M, Deulofeu R, Aponte J H.
Prognostic significance of uric acid serum concentration in patients with acute ischemic
stroke.
Stroke.
2002;
33
1048-1052
- 35
Zoccali C, Mallamaci F, Tripepi G.
Novel cardiovascular risk factors in end-stage renal disease.
J Am Soc Nephrol.
2004;
15(Suppl 1)
S77-S80
- 36
Indridason O S, Quarles L D.
Hyperphosphatemia in end-stage renal disease.
Adv Ren Replace Ther.
2002;
9
184-192
Anna Solini, M. D.
Department of Internal Medicine · Section of Internal Medicine III
Via Roma, 67 · 56100 Pisa · Italy
Telefon: +39 (050) 99 34 82
Fax: +39 (050) 55 32 35
eMail: a.solini@med.unipi.it
