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Editor's Correspondence
September 27, 1999

Chemical Measurements in Ketoacidosis

Arch Intern Med. 1999;159(17):2089. doi:

I find the article by Dr Fulop and colleagues1 on chemical measurements in ketoacidosis to be deficient on several important issues. The title states that it is about patients with uncontrolled diabetes mellitus, and yet 6% of the episodes studied were "in patients without diabetes." Which patients made up the study is further confused in the following statement: "We included nearly all of the adult patients with diabetic ketoacidosis," which ignores the subjects who did not have diabetic ketoacidosis. I take "nearly all" to mean "all the patients who we think had what we wanted to study and whose records we could find." There is no definition of ketoacidosis, or even of acidosis. There is no distinction made between acidosis and acidemia, a crucial omission since some of the patients had "normal or elevated" levels of carbon dioxide. One might assume that the distinctive characteristic that characterized the patients included was, then, an elevated anion gap, yet it is stated that "the AG [anion gap] was misleadingly low in a few of our patients."