Compensatory hypochloraemic alkalosis in diabetic ketoacidosis

Abstract

ObservationsCompensatory hypochloraemic alkalosis in diabetic ketoacidosis fects on cardiac, respiratory and metabolic function [1]. The only known compensatory response to metabolic acidosis in DKA is hyperventilation with consecutive respiratory alkalosis [1].The effect of chloride on acid-base state has been known for many years. Hyperchloraemia and hypochloraemia cause metabolic acidosis and metabolic alkalosis, respectively [2,3]. Recent research indicates that changes in chloride play an important role in the compensation of lactic acidosis [4]. Although chloride concentrations are frequently decreased in DKA, it is not known, whether these changes play a role in the acid-base state in this entity. The aim of this study was to investigate the effect of hypochloraemic alkalosis on acid-base state of patients with DKA.A total of 21 patients with DKA (11 women, 10 men, 44±16 years) admitted to the emergency department of a primary care hospital were studied. Fluid, insulin or bicarbonate had not been administered before the investigation. Of these patients, four had new onset diabetes and 17 patients had known insulin-dependent diabetes. DKA was triggered by inadequate insulin dose in three patients, by infection in nine patients and by unknown cause in nine patients. Arterial blood samples were collected from an indwelling arterial catheter and laboratory parameters were measured immediately after drawing. The pH was ≤7.3 or serum bicarbonate ≤15 mmol/l and ketonuria and glucosuria were present in all patients. The ten healthy control subjects consisted of five women and five men with a mean age of 39±12 years.Acid-base state was assessed using a physical-chemical analysis, which is based on the electroneutrality of plasma.

Das Säure-Basen-Modell nach Stewart

“…Dementsprechend findet sich bei diabetischer Ketoazidose bei Analyse mittels Stewart's approach eine erhöhte SIG [79]. Darüber hinaus konnte mit dieser Methode bei Patienten mit diabetischer Ketoazidose auch eine zusätzliche hypochlorämische Alkalose nachgewiesen werden [79].…”

Acidosis-Induced Hypochloremic Alkalosis in Diabetic Ketoacidosis Confirmed by The Modified Base Excess Method

“…In these human studies, the Cl/Na ratio was used to detect hypochloremia, serum ketone levels were not measured, and it is unknown whether the participants had vomiting. However, significant inverse relationship was observed between the Cl/Na ratio and SIG (21)(22)(23).…”

“…doi: 10.1210/jc.2016-1324 press.endocrine.org/journal/jcem (23). In these human studies, the Cl/Na ratio was used to detect hypochloremia, serum ketone levels were not measured, and it is unknown whether the participants had vomiting.…”

Untitled

“…In addition, several authors have documented relative hypochloraemia when tissue acidosis occurs, postulating that this represents a compensatory mechanism [8,19]. Neither phenomenon will be apparent from an unpartitioned base deficit.…”