Acute Vascular Events and Electrolytes Variations in Elderly Patients

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.

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