Abstract
In the recovery stage of 8 patients with diabetic ketoacidosis, the oxygen transport system of erythrocyte hemoglobin was studied by measuring the oxyhemoglobin dissociation curve (ODC), red cell2, 3-diphosphoglycerate (2, 3-DPG), hemoglobin A1 (Hb A1) and plasma inorganic phosphate (Pi) Administration of insulin was carried out by a continuous intravenous infusion method of low-dose, and ODC was determined with an AMINCO HEM-O-SCANTM analyzer. The following results were obtained.
1) The venous pH was definitely decreased on admission (7.07±0.03, mean±SE), but increased to the normal range within 24 hours after treatment in all patients.
2) The average of the P50in vivo pH was increased before the insulin infusion (31.0±0.9 mmHg), but gradually decreased to within normal limits during24hours following the insulin infusion in7patients and after treatment for 3 days in the other patient.
3) 2, 3-DPG was low in concentration before the treatment (2.4±0.3μmol/ml RBC), and it took 24 hours to return to normal in 3 of 8 patients, 3 days in another 3 patients, and one week in one patient.The remaining patient always maintained a normal level throughout the entire course of recovery.
4) Pi which was normal or a little higher on admission showed a precipitous fall24 hours after the insulin therapy.It took 3 days to return normal in 5 patients an one week in 3 patients.
5) Throughout the course of recovery from diabetic ketoacidosis, there was a highly significant inverse correlation between the P50in vivo pH and venous pH or Pi.Pi was correlated with pH significantly and P50pH7.4 was closely correlated with 2, 3-DPG.
Accordingly, during the continuous intravenous infusion therapy with low-dose insulin for ketoacidotic diabetics, no striking fall in the P50in vivo pH was noted, and it is suggested that no impairment of oxygen transport occurred because of the rapid recovery of 2, 3-DPG and probably of Pi in this study.
