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DIABETIC acidosis.

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Diabetes Mellitus↗

The epidemiology of diabetic acidosis: a population-based study.

A 12-month epidemiologic study in 1979 and 1980 of all diabetic acidosis admissions to all acute care hospitals in Rhode Island detected 152 episodes occurring in 137 persons. Eleven per cent of diabetic acidosis admissions presented in coma and the overall death-to-case ratio was 9%. Newly diagnosed diabetes accounted for 20% of these episodes, while persons having multiple episodes during the year accounted for 15% of the admissions. The annual rate of diabetic acidosis was 46 per 10,000 diabetics. Highest rates of diabetic acidosis were found for the elderly, those admitted from nursing homes and those residing in one geographic area of the state. For known diabetics with an admission for acidosis, 87% were on insulin prior to admission and 81% were nonobese. Patients seldom contacted physicians prior to admission. Insulin dose or frequency was often (40%) changed in the two weeks prior to admission. Most of the known diabetic cases of acidosis had emergency admissions for diabetes in the three-year period prior to admission and few had any structured diabetic outpatient education. Infection and noncompliance were the most frequently identified precipitants of diabetic acidosis occurring in known diabetics.

Adolescent↗

Acid production in diabetic acidosis; a more rational approach to alkali replacement.

The production of organic acids in severe diabetic acidosis was studied to determine the contribution of various acids and to reassess alkali requirements. In 11 patients the mean total concentration of determined organic acids was 16 mEq/l., while the mean estimated base deficit was 24 mEq/l. Acetoacetic and beta-hydroxybutyric acids accounted for 75% of measured organic acid. In 10 patients the mean amount of sodium bicarbonate administered for correction of the acidosis was 185 mEq, while the mean requirement was 394 mEq.These findings imply that the methods commonly used to determine the base deficit and the alkali requirements in patients with diabetic acidosis may be invalid. The prompt administration of alkali should be limited, and we suggest that the blood pH should be restored only to 7.25.

Acetoacetates↗