TY - JOUR
T1 - Plasma Acid-Base Patterns in Diabetic Ketoacidosis
AU - Adrogué, Horacio J.
AU - Wilson, Howard
AU - Boyd, Aubrey E.
AU - Suki, Wadi N.
AU - Eknoyan, Garabed
PY - 1982/12/23
Y1 - 1982/12/23
N2 - In a study of the types of plasma acid-base patterns present at 196 admissions for diabetic ketoacidosis we found no relation between the initial level of serum total carbon dioxide and the plasma anion gap; instead, there was a broad spectrum of acid-base patterns, ranging from pure anion-gap acidosis to pure hyperchloremic acidosis. Although the degree of renal dysfunction on admission, which reflected the magnitude of volume depletion, was independent of the severity of metabolic acidosis, it was responsible for the variable retention of plasma ketones: the more severe the volume depletion on admission, the greater the ketone retention and the less prominent the hyperchloremic acidosis. Recovery from acidosis was significantly slower in patients admitted with pure hyperchloremic acidosis. After therapy hyperchloremia developed in most patients at four to eight hours after admission, because of the retention of chloride in excess of sodium and the excretion of ketones by the kidney.
AB - In a study of the types of plasma acid-base patterns present at 196 admissions for diabetic ketoacidosis we found no relation between the initial level of serum total carbon dioxide and the plasma anion gap; instead, there was a broad spectrum of acid-base patterns, ranging from pure anion-gap acidosis to pure hyperchloremic acidosis. Although the degree of renal dysfunction on admission, which reflected the magnitude of volume depletion, was independent of the severity of metabolic acidosis, it was responsible for the variable retention of plasma ketones: the more severe the volume depletion on admission, the greater the ketone retention and the less prominent the hyperchloremic acidosis. Recovery from acidosis was significantly slower in patients admitted with pure hyperchloremic acidosis. After therapy hyperchloremia developed in most patients at four to eight hours after admission, because of the retention of chloride in excess of sodium and the excretion of ketones by the kidney.
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U2 - 10.1056/NEJM198212233072603
DO - 10.1056/NEJM198212233072603
M3 - Article
C2 - 6815530
AN - SCOPUS:0020379999
SN - 0028-4793
VL - 307
SP - 1603
EP - 1610
JO - New England Journal of Medicine
JF - New England Journal of Medicine
IS - 26
ER -