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April 1978

Diabetic Ketoacidosis-Reply

Arch Intern Med. 1978;138(4):660. doi:10.1001/archinte.1978.03630280104041

In Reply.—  Dr Kumar and colleagues have drawn attention to two issues. Firstly, with respect to the trend to hypomagnesemia developing in patients during insulin therapy, the observations are interesting and informative. They would have been more informative if Dr Kumar and associates had been able to directly compare the changes in serum magnesium levels between the intermittent high-dose insulin therapy group with the constant intravenous insulin therapy group in the more recent communication by Piters et al,1 rather than comparing these new values with those reported almost 20 years ago by Martin et al.2Secondly, Dr Kumar and associates have misinterpreted our conclusions. The management of each case of diabetic ketoacidosis requires close scrutiny and vigilance on an individual basis by the responsible physician. The execution of physicians' orders, irrespective of the method used to treat diabetic ketoacidosis, continues to be performed by the nursing staff. We