Abstract

Hemodialysis in the diabetics with renal failure presents a special problem because of the accentuated hyperglycemia and hyperosmolality which may precipitate nonketotic coma. The authors intend to report their experience with 5 hemodialysises in a 56 year-oId Korean male patient with renal failure and massive anasarca due to diabetic glomeruloaclerosis. Because of progressive edema and uremic symptoms, hemodialysis was carried out on 5 occasions at weekly interval with different insulin dosages and various amounts of glucose and mannitoI added to dialyzing solution. Kolff's Twin-coil dialyzer was used. Although reduction in body weight by as much as 3.8kg was achieved with 400'gm of glucose added every hour to the dialyzing solution, the blood glucose leveIs rose to near 300 mg when the patient developed hedache, nausea, vomiting and hypertension. Satisfactory result was obtained with moderate reduction in body weight (2. 5 kg) and with little fluctuations in glucose level, requiring no additional insulin, when mannitoI was added every hour to the dialyzing solution.