Plasma acid-base patterns in diabetic ketoacidosis

Area of Science:

• Nephrology
• Endocrinology
• Internal Medicine

Background:

• Diabetic ketoacidosis (DKA) is a serious complication of diabetes.
• Understanding DKA's acid-base disturbances is crucial for effective management.
• Previous studies have focused on specific acid-base profiles in DKA.

Purpose of the Study:

• To investigate the spectrum of plasma acid-base patterns in patients admitted with DKA.
• To determine the relationship between initial serum total carbon dioxide, plasma anion gap, and renal dysfunction.
• To analyze factors influencing recovery from acidosis in DKA.

Main Methods:

• Analysis of plasma acid-base parameters in 196 DKA admissions.
• Assessment of initial serum total carbon dioxide and plasma anion gap.
• Evaluation of renal dysfunction and its correlation with metabolic acidosis severity and ketone retention.

Main Results:

• No direct correlation found between initial serum total carbon dioxide and plasma anion gap in DKA.
• A wide range of acid-base patterns observed, from pure anion-gap acidosis to pure hyperchloremic acidosis.
• Renal dysfunction, reflecting volume depletion, independently affected ketone retention and acidosis severity.
• Recovery from acidosis was slower in patients with pure hyperchloremic acidosis.
• Post-treatment hyperchloremia developed due to chloride retention and sodium excretion.

Conclusions:

• DKA exhibits diverse acid-base disturbances beyond simple anion-gap acidosis.
• Volume depletion and renal function significantly modulate acid-base balance and ketone metabolism in DKA.
• Hyperchloremic acidosis in DKA may indicate slower recovery and requires specific therapeutic considerations.