[Diabetic ketoacidosis. Revision of 82 episodes].

A total of 82 episodes of diabetic ketoacidosis were analysed in 70 adult patients. Population characteristics can be seen in Table 1. It was possible to determine the causes of 74 episodes (Table 2); infections, insulin reduction or suppression and psychic stress included 89 % of these causes. The most frequent infection sites were airway, urinary tract and skin surface. The most important symptoms and signs shown by patients on admission (Table 3) were digestive and those derived from dehydration and acidosis. Figure 2 shows laboratory data on admission: average glycemia, 395 mg %, 90 % with pH values below 7.30; the majority revealed high hematocrit urea and kaliemia values. Unusual treatment performed in the classical way (Figure 3) can be divided into two periods: the first of eapid expansion and insulinization (first three hours) and the second of slow replenishment (4 to 24 hours) consisting of two stages in which the velocity of liquid infusion is diminished while glucose and potassium backing is started. No difference was found between the results of those who received bicarbonate and those who did not (Table 4). Response to treatment is shown in Fig. 4. On pointing out the decrease in kalemia (1.18 mEq/l in the first 6 hours), however, it must be kept in mind that on admission 10 % of the patients were in a state of hypokalemia with less than 3.5 mEq/l. Table 5 shows complications that arose during treatment: hypokalemia, 32 %; hupoglucemia, 11 % and phlebitis, 17 % (catheterized). Five patients, (7 5) died. Four had been admitted in a state of coma with a severe infectious state (bronchopneumonia, acute pyelonephritis, meningo-encephalitis). The analysis of this paper shows the importance of an adequate diabetic education and briefing both for the patients, to be aware of the unleashing factors, and for the physicians, in order to avoid the complications of treatment.