title: Acid-base and electrolyte disturbances in patients with diabetic ketoacidosis.
abstract: We undertook the present study to examine the acid-base and electrolyte disturbances in relation to hydration status in patients with diabetic ketoacidosis (DKA). A total of 40 insulin-dependent diabetes mellitus patients (22 male, 18 female), aged 18-61 years with DKA admitted to our hospital during the last 2 years, were studied. The duration of diabetes averaged 9 +/- 2 years. In all cases a detailed investigation of the acid-base status and electrolyte parameters was performed. Twenty-one patients had a pure metabolic acidosis with an increased serum anion gap, seven had DKA combined with hyperchloremic metabolic acidosis, nine had DKA coexisting with metabolic alkalosis, while three had DKA with a concurrent respiratory alkalosis. Hydration status as evidenced by the ratio of urea/creatinine seems to play an important role in the development of mixed acid-base disorders (detected by changes in the ratios delta anion gap/delta bicarbonate (delta AG/delta HCO3) and sodium/chloride (Na/Cl)). In fact, hyperchloremic acidosis developed in the patients with the better hydration status. However, contradictorily, the severely dehydrated patients who experienced recurrent episodes of vomiting developed DKA with a concurrent metabolic alkalosis. Finally, patients with pneumonia or gram-negative septicemia exhibited DKA combined with a primary respiratory alkalosis. We conclude that patients with DKA commonly develop mixed acid-base disorders, which are partly dependent on patients' hydration status.
authors.affiliation: Department of Internal Medicine, University of Ioannina Medical School, Greece.
authors.forename: M S
authors.initials: MS
authors.lastname: Elisaf
authors.forename: A A
authors.initials: AA
authors.lastname: Tsatsoulis
authors.forename: K P
authors.initials: KP
authors.lastname: Katopodis
authors.forename: K C
authors.initials: KC
authors.lastname: Siamopoulos
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D001786:Blood Glucose / Q000032:analysis; D001798:Blood Proteins / Q000032:analysis; D003404:Creatinine / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000097:blood*; D016883:Diabetic Ketoacidosis / Q000097:blood*; D004573:Electrolytes / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D014508:Urea / Q000097:blood; D014883:Water-Electrolyte Imbalance / Q000097:blood* / Q000209:etiology
chemical_list: D001786:Blood Glucose; D001798:Blood Proteins; D004573:Electrolytes; D014508:Urea; D003404:Creatinine