THE NATURE OF DIABETIC ACIDOSIS

Abstract

The concentration of total base, of the proteins, bicarbonate, chloride and phosphate of serum was studied in 40 cases at the height of acidosis and com pared with blood sugar, ketonuria and general clinical manifestations, in an attempt to evaluate the dis turbances of electrolyte and water equilibria in the body and their therapeutic implications. The nature and mode of production of the abnormal serum electrolyte patterns in diabetic acidosis are discussed from a theoretical stand point and those observed in a considerable number of cases analyzed. These patterns are characterized by ex- treme diversity which can not always be clearly related to distinctive features of the disease. It is pointed out that base from which bicarbonate has been displaced by ketones within the body may be considered as base available for combination with bicarbonate by simple reversal of the disorder of carbohydrate metabolism which led to ketosis. Base sacrificed in the urine with ketones can only be restored from extraneous sources. The amount of base lost in this manner, however, in the great majority of cases falls far short of the quantity sacrificed with chloride. The actual deficiency of body chloride is far greater than concentration deficits would indicate if there is associated loss of body fluid, and far exceeds the deficiency of bicarbonate, if in the latter is included potential bicarbonate represented by the fraction of base combined with ketones.