Disorders of Fluids and Electrolytes Acid-Base Problems in Diabetic Ketoacidosis

This review focuses on three issues facing clinicians who care for patients with diabetic ketoacidosis; all of the issues are related to acid-base disorders. The first issue is the use of the plasma anion gap and the calculation of the ratio of the change in this gap to the change in the concentration of plasma bicarbonate in these patients; the second concerns the administration of sodium bicarbonate; and the third is the possible contribution of intracellular acidosis to the development of cerebral edema, particularly in children with diabetic ketoacidosis. In this article, we examine the available data and attempt to integrate the data with principles of physiology and metabolic regulation and provide clinical guidance. Copyright © 2015 Massachusetts Medical Society.