Treatment of Severe Diabetic Acidosis

Hartmann, Alexis F.

doi:10.1001/archinte.1935.00170010001001

Cited by 16 publications

(2 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The question whether lactic acid may contribute to the acidosis in patients with diabetic ketoacidosis is sporadically brought up in the older literature (5). However, only a single publication concentrating on this problem has appeared previous to our study (10).…”

Section: Discussionmentioning

confidence: 96%

Blood Lactate and Ketone Bodies in Diabetic Ketoacidosis

Strandgaard

Nielsen

Bitsch

et al. 1971

Journal of Internal Medicine

View full text Add to dashboard Cite

Abstract. Arterial blood lactate, pyruvate, plasma β‐hydroxybutyrate and acetone have been followed in 12 patients with diabetic ketoacidosis during the initial 24‐hour treatment period. In all cases the acidosis was fully explained by the accumulation of ketone bodies, and blood lactate and pyruvate never exceeded normal values. A slight rise was, however, observed in blood lactate in some patients during the treatment. Some possible explanations of this phenomenon are discussed. β‐hydroxybutyrate was cleared from the plasma much faster than acetone, and the ratio between the ketone bodies was constantly changing during treatment of the acidosis.

show abstract

Section: Discussionmentioning

confidence: 96%

Blood Lactate and Ketone Bodies in Diabetic Ketoacidosis

Strandgaard

Nielsen

Bitsch

et al. 1971

Journal of Internal Medicine

View full text Add to dashboard Cite

show abstract

“…It was recognized that in addition to insulin, fluid therapy was also necessary to adequately treat DKA. While it was recognized as early as 1935 that salt solutions buffered with bicarbonate or lactate resulted in faster correction of metabolic acidosis [1 ▪ ], it was not until the 1970s that the modern regime of low dose intravenous insulin infusion (typically 0.05 to 0.10 units/kg/h) together with large volume intravenous fluids (60–100 ml/kg over 24–36 h) became standard practice in DKA management [2,3]. Broadly speaking, the type of fluids which have been used in DKA management may be categorized into hypotonic fluids and isotonic fluids, with the isotonic fluids further sub-categorized into saline (0.9% sodium chloride) and balanced crystalloid solutions, including compound sodium lactate and Plasmalyte-148).…”

Section: Historymentioning

confidence: 99%

Fluid therapy in diabetic ketoacidosis

Ramanan,

Delaney,

Venkatesh

2023

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

View full text Add to dashboard Cite

Purpose of review To evaluate recent evidence (2021–2023) on fluid therapy in diabetic ketoacidosis. Key evidence gaps which require generation of new evidence are discussed. Recent findings Balanced crystalloid solutions, compared to the commonly recommended and used 0.9% sodium chloride solution (saline), may result in better outcomes for patients with diabetic ketoacidosis, including faster resolution of acidosis, less hyperchloremia and shorter hospital length of stay. Upcoming results from randomized trials may provide definitive evidence on the use of balanced crystalloid solutions in diabetic ketoacidosis. Evidence remains scarce or conflicting for the use of “two-bag” compared to conventional “one-bag” fluid, and rates of fluid administration, especially for adult patients. In children, concerns about cerebral oedema from faster fluid administration rates have not been demonstrated in cohort studies nor randomized trials. Summary Fluid therapy is a key aspect of diabetic ketoacidosis management, with important evidence gaps persisting for several aspects of management despite recent evidence.

show abstract