Regulation of plasma aldosterone by glucose-induced paradoxical hyperkalemia in the presence of suppressed renin-angiotensin system.

In a hyperkalemic patient with stable chronic renal failure and suppression of the renin-angiotensin-aldosterone system intravenous infusion of hypertonic glucose induced a paradoxical transitory rise in serum potassium accompanied by a similar change in plasma aldosterone. The close significant correlation indicated a prominent role for serum potassium in the acute regulation of plasma aldosterone when the renin-angiotensin-aldosterone system was suppressed. However, when the renin-angiotensin-aldosterone system was stimulated by sodium depletion the glucose-induced paradoxical hyperkalemia was abolished and the governing role of potassium became less evident. The results support the concept of an equal and supplementary role of renin-angiotensin-aldosterone system and potassium in the acute regulation of aldosterone production.