Acid-base Disturbances in Japanese Patients with Diabetic Ketoacidosis

Abstract

Acid-base disturbances in Japanese patients with diabetic ketoacidosis (DKA) were studied. Plasma acid-base patterns in 18 patients at the time of 21 admissions to our hospitals were analyzed. The coexistence of primary metabolic acid-base disturbances with DKA was defined by the fulfillment of all of the following criteria: (1) corrected HCO₃^-[Δ anion gap (AG)+plasma HCO₃^-]: <22mEq/l or>26 mEq/l, (2) ΔAG/ΔHCO₃^-: <0.8 or>1.2, and (3) (AG-10)/ΔHCO₃^-: <1.0 or>1.6. Combined respiratory disturbance(s) with DKA were diagnosed by the fulfillment of (4) pCO₂>or<1.5xHCO₃^-+8±2, and (5) ΔpCO₂>or<ΔHCO₃^-x(1∼1.3). Pure DKA and mixed acid-base disorders were observed in 9 cases (43%) and 12 cases (57%), respectively, and the latter group consisted of 6 patients with metabolic alkalosis, 3 with respiratory alkalosis, and 3 with triple acid-base disorder. In concusion, the occurrence of mixed acid-base disorder is very common in Japanese DKA patients. The association of other acid-base disturbances with DKA should always be kept in mind in clinical practice.