Diagnosis of mixed acid-base disorders in diabetic ketoacidosis

W. D. Paulson, M. F. Gadallah

Research output: Contribution to journalArticle

12 Scopus citations

Abstract

In diabetic ketoacidosis, a mixed acid-base disorder is suggested when the anion gap increase (ΔAG) does not equal the bicarbonate decrease (ΔHCO3), or when the ΔAG/ΔHCO3 ratio does not equal 1.0. It is widely assumed that ΔAG/ΔHCO3 is significantly different from 1.0 when it is less than 0.8 or greater than 1.2. The validity of these ratio limits were examined by analyzing a normal control group of 68 subjects and 27 diabetic ketoacidosis admissions that had no evidence of mixed disorders. In the 27 ketoacidosis admissions, regression analysis showed that ΔAG was predicted to equal ΔHCO3, as expected in pure anion gap acidosis: ΔAG = 1.0ΔHCO3 (r = 0.744, p < 0.001). It was found that ΔAG is significantly different from ΔHCO3 when they differ by more than 8 mEq/L, and equivalently, ΔAG/ΔHCO3 is significantly different from 1.0 when it is less than (1.0 - 8/ΔHCO3) or greater than (1.0 + 8/ΔHCO3). These criteria from regression analysis suggested that 4% of the 27 pure anion gap acidoses, and 3% of the control group, had mixed disorders. In contrast, the ratio limits of 0.8 and 1.2 suggested 56% of the pure anion gap acidoses, and 94% of the control group, had mixed disorders. It was concluded that mixed disorders are overdiagnosed by the ratio limits of 0.8 and 1.2. Mixed disorders are more accurately detected by noting whether ΔAG and ΔHCO3 differ by more than 8 mEq/L.

Original languageEnglish (US)
Pages (from-to)295-300
Number of pages6
JournalAmerican Journal of the Medical Sciences
Volume306
Issue number5
DOIs
StatePublished - Jan 1 1993

Keywords

  • Acid-base imbalance
  • Anion gap
  • Diabetic acidosis
  • Metabolic acidosis

ASJC Scopus subject areas

  • Medicine(all)

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