M. Güzel, M. Yadigaroğlu, M. Ocak, A. Durmuş, VF. Atmaca, A. Kayabaş, NÖ. Yadigaroğlu, et al. (2026). Clinical value of base excess in risk stratification of diabetic ketoacidosis in the emergency setting. Internal and emergency medicine, 21(2), 469-476. https://doi.org/10.1007/s11739-025-04185-x

PubMed 41214413

[Abstract]
Diabetic ketoacidosis (DKA) is a life-threatening endocrine emergency characterized by metabolic acidosis, hyperglycemia, and ketonemia. Although pH and bicarbonate (HCO₃⁻) levels are commonly used to classify the severity of diabetic ketoacidosis (DKA), base excess (BE) is not included in the current classification. BE is defined as the amount of acid or base required to restore blood pH to normal under standardized conditions. This study evaluated the relationship between BE and DKA severity in patients presenting to the emergency department (ED).This retrospective observational study included adult patients (≥ 18 years) diagnosed with DKA in a tertiary ED between January 2022 and December 2024. Data on venous blood gas parameters-pH, HCO₃⁻, lactate, BE, and anion gap-were collected at 0, 4, 12, and 24 h. Patients were stratified into mild, moderate, or severe DKA based on American Diabetes Association criteria, which consider factors such as arterial pH, serum HCO₃⁻ level, and mental status, to determine the severity of the condition. 44 patients (mean age 49.72 ± 19.11 years; 59.1% male) were analyzed. At admission, BE values were significantly more negative in the severe DKA group (p < 0.001), correlating with lower pH and HCO₃⁻ levels. Across all time points, BE demonstrated significant differences by severity and showed progressive normalization, with delayed recovery in cases of severe disease. A BE cutoff of -14.2 identified moderate/severe DKA with 73.1% sensitivity and 94.4% specificity (AUC: 0.858; 95% CI: 0.720-0.945). BE, a sensitive marker for metabolic acidosis, correlates strongly with DKA severity. The routine use of BE, similar to HCO₃⁻, may support improved clinical management of DKA in emergency settings.