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June 26, 1987

Hypokalemic Respiratory Arrest in Diabetic Ketoacidosis-Reply

Author Affiliations

Santa Clara Valley Medical Center San Jose, Calif

Santa Clara Valley Medical Center San Jose, Calif

JAMA. 1987;257(24):3364. doi:10.1001/jama.1987.03390240069020

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In Reply.—  Hypomagnesemia can occur in diabetic ketoacidosis and has been associated with a decrease in respiratory muscle power, as pointed out by Drs Ryzen and Rude. In our patient, the serum magnesium levels were 2.2 mg/dL (0.9 mmol/L) at the time of the respiratory arrest, 3.9 mg/dL (1.6 mmol/L) 12 hours after arrest, and 2.4 mg/dL (1.0 mmol/L) three days after arrest. These levels are all in or slightly above the normal range for our laboratory (1.7 to 2.80 mg/dL [0.7 to 1.15 mmol/L]). Thus, hypomagnesemia was not a factor in this case, but the point that serum magnesium should be monitored in such patients is valid.At the time of admission, abdominal examination of our patient revealed the presence of bowel sounds and no tenderness on several different examinations. There was no nausea, vomiting, or abdominal pain. It is unlikely that there was malabsorption of the oral potassium