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April 1978

Diabetic Ketoacidosis

Author Affiliations

Los Angeles

Arch Intern Med. 1978;138(4):660. doi:10.1001/archinte.1978.03630280104040

To the Editor.—  Alberti's recent review1 of low-dose insulin treatment of diabetic ketoacidosis emphasizes the effectiveness of this therapy. In the study by Piters et al,2 the decline in the level in blood ketone bodies was also comparable in patients who were treated with conventional doses (50 units intravenously every two hours) or continuous intravenous infusions (10 units/hr).In addition to the well-recognized benefits1-3 of low-dose insulin, ie, decreased risk of hypoglycemia, hypokalemia, hyperlactatemia, and osmotic disequilibria, the following observations suggest that the problem of hypomagnesemia is also minimized.We have monitored the serum magnesium levels in eight patients with diabetic ketoacidosis (Table) during continuous intravenous insulin infusion (10 units/hr). One patient had hypomagnesemia with a serum magnesium level of 1.4 mg/dl (normal range, 1.5 to 2.5 mg/dl) at the initiation of treatment. As therapy progressed, serum magnesium levels declined gradually but remained within normal range in