A 16 year old male has been treated all night for diabetic ketoacidosis. In the morning the blood gas printout is as follows:
Barometric pressure |
760mm Hg |
|
FiO2 |
0.21 |
|
pH |
7.32 |
|
pO2 |
100 mm Hg(13.3 kPa) |
|
pCO2 |
30 mm Hg (4 kPa) |
|
HCO3- |
15.0mmol/L |
|
Standard base excess |
-9.9mmol/L |
|
Sodium |
135mmol/L |
(135 – 145) |
Chloride |
114mmol/L |
(100 -110) |
Potassium |
3.5mmol/L |
(3.2 - 4.5) |
Lactate |
1.3mmol/L |
(0.2 - 2.5) |
Glucose |
14.3mmol/L |
(3.6 – 7.7) |
a) Describe the acid-base status.
b) Has the keto-acidosis resolved? Give your reasoning.
Q7.1a) Normal anion gap metabolic acidosis with appropriate respiratory compensation.
Q7.1b) Yes The anion gap is normal, indicating resolution of ketoacidosis. The persistent acidosis reflects saline fluid replacement coupled with the chloride retention during the period of ketonuria.
Let us dissect these results systematically.
Has the ketoacidosis resolved? Well, there is no more anion gap, so yes- one would be forced to conclude that it has. A normal anion gap acidosis now prevails, likely due to either vigorous resuscitation with normal saline, or to the normal hyperchloraemia in the recovery phase of ketoacidosis.
Oh, M. S., H. J. Carroll, and J. Uribarri. "Mechanism of normochloremic and hyperchloremic acidosis in diabetic ketoacidosis." Nephron 54.1 (1990): 1-6.