Endocrine Abstracts

Introduction: Diabetic ketoacidosis is a metabolic event that occurs as a result of the absence or deficiency of insulin and the increase in contrinsuliner hormones, resulting in disruption of electrolyte and water regulation. In this study, it was planned to investigate the changes in ANP, copeptin, renin, aldosterone levels before and after rehydration and insulin therapy in pediatric patients with a diagnosis of diabetic ketoacidosis followed in the pediatric endocrinology clinic, so that the results obtained will shed light on the pathophysiology of diabetic ketoacidosis.

Materials and methods: Our study is a prospective study and we evaluated the serum osmolality, serum sodium and plasma glucose levels and the degree of dehydration, and the dynamic changes of ANP, copeptin, renin and aldosterone levels due to rehydration and insulin therapy in 31 patients who were followed up in our clinic with the diagnosis of diabetic ketoacidosis. The study was supported by the Atatürk University Scientific Research Projects Commission (TTU-2021-9262).

Results: While ANP increased statistically significantly, other parameters were found to decrease statistically significantly after treatment (P=0.001). When the correlation between the ANP, copeptin, renin and aldosterone levels of the patients at the time of diabetic ketoacidosis was examined; there was a statistically significant negative correlation between ANP and copeptin, between ANP and renin, and between ANP and aldosterone. In addition, there was a statistically significant positive correlation between copeptin and renin (P<0.001). Also, when the patients with diabetic ketoacidosis included in the study were grouped as severe and mild-moderate ketoacidosis according to pH values, it was determined that there was no significant difference between the two groups in terms of serum ANP and copeptin values, but renin and aldosterone values were higher in severe diabetic ketoacidosis.

Conclusion: Copeptin may be a reliable marker of AVP secretion and may replace AVP in measuring circulating AVP levels in clinical routine. Both the renin angiotensin aldosterone system and the vasopressin system are involved in the hemodynamic impairment during diabetic ketoacidosis. Renin aldosterone and copeptin levels are initially elevated in patients with diabetic ketoacidosis. Serum copeptin level and secretion are not driven by serum sodium concentration.