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 Hypo or hypernatremia?  

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Can Anyone clarify this for me please? This is about Serum sodium level in
both DKA and hyperosmolar Coma.

I understand that DKA causes dilutional Hyponatremia. Kaplan says Hyperosmolar
coma causes Hypernatremia due to Osmotic diuresis.

Both DKA and Hyperosmolar coma has Osmotic diuresis (The only difference is
the presence or absence of Ketone bodies), But how come the same mechanism
causes opposite effect Hyponatremia (In DKA) and hypernatremia (In HHS) at the same time?

I am confused about this fact as well as the mechanism if this is true. Can anyone



There is hyponatremia in both instances, because hyperglycemia = above normal POsm, fluid moves ICF->ECF and dilutes the serum producing hyponatremia. Sodium is also lost in the urine, but main mechanism is dilution of the ECF.

I cannot see how this, supposedly according to Kaplan, should be true only for DKA, but not for HNKC. Could you provide a reference (page number)? If you don't have the 2009-2010 version of LN, then please be more specific, i.e. page number + chapter + headline.


Thanks for the explanation. Sorry it is not in KPN lecture notes but I found this
point in one of the explanations for a Q bank question. Unfortunately I didn't note down the Question ID and my subscription expired already.

But thanks a lot for clarifying my doubt.

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