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To the Editor.—
This reply is in answer to the letter of Clifford W. Zwillich, MD (211:829, 1970). (1) While recognizing the problem of hyperosmolality in untreated diabetic "coma," we feel early correction of acidosis and decreased extracellular fluid volume have priority and are best accomplished with the bicarbonate saline mixture recommended in our treatment schedule. It was indicated, also, that hypotonic saline solution, 0.45% sodium chloride, may be given as early as the second liter of fluid. (2) The following points are made concerning potassium therapy in the presence of azotemia. The azotemia seen in diabetic "coma" is usually of the prerenal type subsequent to osmotic diuresis with resulting severe fluid loss and decreased renal function. This usually causes a rise in serum potassium level. Acidosis, also, usually causes a rise in serum potassium level due to the shift of potassium from the intracellular to the extracellular space
Beigelman PM, Martin HE. Diabetic Ketoacidosis. JAMA. 1970;212(10):1706. doi:10.1001/jama.1970.03170230108023
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