Severe diabetic ketoacidosis is defined by us as a ketoacidotic state with serum bicarbonate decreased to levels of 10 mEq/liter or less. A synonymous term used in the past was "chemical diabetic coma." Although patients are often mentally obtunded and sometimes unconscious, these features are not essential components of the severe ketoacidotic state.
Successful management is based on competent monitoring of the clinical and chemical status of the patient. A short-term study of 51 episodes of severe diabetic ketoacidosis in 46 patients admitted to our service, included in this presentation, has emphasized the importance of well-directed management in preventing fatal outcome.
Other causes of metabolic acidosis must also be considered. Renal acidosis reflects the failure of the kidney to excrete acid metabolites. Lactic acidosis is due to an excess of lactic acid and usually accompanies tissue anoxia when oxidative metabolism cannot be sustained because of circulatory failure. Another disorder that