Acid-base Disturbances in Japanese Patients with Diabetic Ketoacidosis

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  • Tanahashi Hiromichi
    Department of Internal Medicine and Center for Lifestyle-related Disorders, Matsunami General Hospital
  • Yasuda Keigo
    Department of Internal Medicine and Center for Lifestyle-related Disorders, Matsunami General Hospital
  • Hayashi Makoto
    Department of Internal Medicine and Center for Lifestyle-related Disorders, Matsunami General Hospital
  • Hashimoto Kenichi
    Department of Internal Medicine and Center for Lifestyle-related Disorders, Matsunami General Hospital
  • Sugiyama Chiyo
    Department of Internal Medicine and Center for Lifestyle-related Disorders, Matsunami General Hospital
  • Asakawa Hidenori
    Department of Internal Medicine and Center for Lifestyle-related Disorders, Matsunami General Hospital
  • Ishihara Shinichiro
    Department of Internal Medicine and Center for Lifestyle-related Disorders, Matsunami General Hospital
  • Yoshida Kenichiro
    Department of Internal Medicine and Center for Lifestyle-related Disorders, Matsunami General Hospital
  • Sano Akie
    Department of Internal Medicine and Center for Lifestyle-related Disorders, Matsunami General Hospital
  • Akai Akifumi
    Department of Internal Medicine and Center for Lifestyle-related Disorders, Matsunami General Hospital
  • Ito Yasufumi
    Department of Internal Medicine and Center for Lifestyle-related Disorders, Matsunami General Hospital
  • Murai Toshihiro
    Department of Internal Medicine and Center for Lifestyle-related Disorders, Matsunami General Hospital
  • Yamakita Noriyoshi
    Department of Internal Medicine and Center for Lifestyle-related Disorders, Matsunami General Hospital
  • Sarui Hiroshi
    Department of Diabetes and Endocrinology, Murakami Memorial Hospital, School of Dentistry, Asahi University
  • Takeda Noriyuki
    Department of Diabetes and Endocrinology, Murakami Memorial Hospital, School of Dentistry, Asahi University

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Other Title
  • 糖尿病ケトアシドーシスにおける混合性酸・塩基平衡障害
  • トウニョウビョウ ケトアシドーシス ニ オケル コンゴウセイサン エンキ ヘイコウ ショウガイ

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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.

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