INTRODUCTION
As an acute complication of diabetes, diabetic ketoacidosis (DKA) is
typically characterized with hyperglycemia (16.7-33.3mmol/L,
>55.5 mmol/L in rare case), elevated serum ketones, and
acidosis 1. Whereas DKA patients with normal blood
glucose concentrations (<16.7 mmol/L) and low bicarbonate
levels (<10 mmol/L) were also reported, the pioneer of which
is Munro et al. in 1973 2.
The optimal emergence treatment of DKA is fluids supply, which can
increase blood volume and restore efficient influx of organs. However,
in regarding to patients at the last stage of diabetic nephropathy
relying on sustainable hemodialysis, rapid and large amount of fluids
supply is not feasible since they have no urine and can easily get heart
failure. In this group of patients, normal fluids/blood supply can only
correct the acidosis for short time. Ketones in tissues will enter the
blood and cause acidosis in two to three hours.
For these cases, continuous renal replacement therapy (CRRT) is a better
option in many ways, including large amount fluids exchange, increased
influx of organs, clearance of keto acid, lactic acid and inflammatory
mediator in tissues, enhanced efficiency of essential molecules in
blood, improved microcirculation, remission of tissue hypoxia. Up to
now, there is no report of the treatment of DKA associated with uremia.
Our case report here indicate that normal dialysis could not correct DKA
associated with uremia, while CRRT is the best available option for
treatment.