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Clifford W. Zwillich, MD
Irvine, Calif

JAMA. 1970;211(5):829.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor:—

I read with great interest the article "Severe Diabetic Ketoacidosis" (210:1082, 1969).

The authors suggest that the first intravenous administration should contain "approximately 150 mEq of sodium," and later state that hyperosmolality is common in ketoacidosis. They suggest that the hyperosmotic state be considered after the initial 2,000 cc is already infused. The hyperosmotic state of ketoacidosis should be treated from the onset of therapy as it is not an uncommon cause of early death in ketoacidosis. This can easily be accomplished by using 0.45% sodium chloride solution with 44 mEq sodium bicarbonate added. This would make a solution with about 120 mEq/liter of sodium and would begin immediately to correct the hyperosmotic state.

The article later suggests starting potassium replacement more vigorously if the patient has a known history of azotemia because "potassium levels are already decreased at the time of admission." Treatment of patients . . . [Full Text PDF of this Article]

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