Plasma Acid-Base Patterns in Diabetic Ketoacidosis

Horacio J. Adrogué, Howard Wilson, Aubrey E. Boyd, Wadi N. Suki, Garabed Eknoyan

Research output: Contribution to journalArticlepeer-review

242 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)1603-1610
Number of pages8
JournalNew England Journal of Medicine
Issue number26
StatePublished - Dec 23 1982

ASJC Scopus subject areas

  • Medicine(all)


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