AD. Lopes, AT. Maciel and M. Park (2011). Evolutive physicochemical characterization of diabetic ketoacidosis in adult patients admitted to the intensive care unit. Journal of critical care, 26(3), 303-10. https://doi.org/10.1016/j.jcrc.2010.08.013

PubMed 21036529

[Abstract]
PURPOSE: The aim of this study was to characterize the first 48-hour evolution of metabolic acidosis of adult patients with diabetic ketoacidosis admitted to the intensive care unit.

MATERIALS AND METHODS: We studied 9 patients retrieved from our prospective collected database, using the physicochemical approach to acid-base disturbances.

RESULTS: Mean (SD) age was 34 (13) years; mean (SD) Acute Physiology and Chronic Health Evaluation II score was 16 (10); mean (SD) blood glucose level on admission was 480 (144) mg/dL; mean (SD) pH was 7.17 (0.18); and mean (SD) standard base excess was -16.8 (7.7) mEq/L. On admission, a great part of metabolic acidosis was attributed to unmeasured anions (strong ion gap [SIG], 20 ± 10 mEq/L), with a wide range of strong ion difference (41 ± 10 mEq/L). During the first 48 hours of treatment, 297 ± 180 IU of insulin and 9240 ± 6505 mL of fluids were used. Metabolic improvement was marked by the normalization of pH, partial correction of standard base excess, and a reduction of hyperglycemia. There was a significant improvement of SIG (7.6 ± 6.2 mEq/L) and a worsening of strong ion difference acidosis (36 ± 5 mEq/L) in the first 24 hours, with a trend toward recuperation between 24 and 48 hours (38 ± 6 mEq/L).

CONCLUSION: Initial metabolic acidosis was due to SIG, and the treatment was associated with a significant decrease of SIG with an elevation of serum chloride above the normal range.