Management of Diabetic Ketoacidosis

To the Editor.—  The article "Diabetic Ketoacidosis" by Richard Bienia, MD, and Ignacio Ripoll, MD (241:510, 1979), is a good summary of current practice. However, the excessive blood chemistry studies and invasive monitoring of the patient that they suggest is rarely necessary in restoring the normal chemical balance. Only those procedures of proved benefit should be used. Low-dose intravenous insulin with isotonic saline as the initial hydrating solution followed by glucose in water with potassium phosphate to replace intracellular fluids is noncontroversial. Sodium bicarbonate is used only when the pH is below 7.10. However, the suggestion that determination arterial blood gas, blood glucose, and serum electrolyte levels be performed at hourly intervals is unnecessary, expensive, and traumatic. Every two hours is often enough to check the blood glucose level and every four hours is often enough to check the electrolyte level. Arterial blood gas determinations should be done on admission,