SERUM PROTEINS IN DIABETIC ACIDOSIS

Abstract

The proteins of the serum, O capacity, red cell volume, blood sugar and serum electrolytes were studied in rela tion to chemical and metabolic disturbances during re covery from diabetic acidosis, in order to evaluate the importance of hemoconcentration and general body fluid loss in this condition. In severe acidosis the serum pro teins are usually within or above the normal limits, but fall, during recovery, below the normal. The initial high level seems to be due to hemoconcentration, the sub sequent fall to restoration of normal plasma volume. Both the initial high levels and the later low levels seem to bear some relation to the state of nutrition, being lower in emaciated subjects. The initial hemo concentration is only partly due to depletion of body water, partly to loss of fluid from the vessels into the tissues. Restoration of serum volume is to a large extent independent of the replenishment of general body fluids. When hemoconcentration and hypoproteinemia fail to respond to treatment, low blood pressure and signs of circulatory failure akin to shock are evident. Under these circumstances clinical symptoms, especially the mental state, do not improve. Clinical improvement is better correlated with the changes in serum proteins than with blood sugar, serum bicarbonate or ketonuria. It is suggested that the state of shock and its attendant hemoconcentration may be at least contributory causes of the coma of diabetic acidosis.