Diabetic ketoacidosis is associated with severe loss of water and electrolytes. The loss of fluid can be up to 50% of body weight and is associated with a reduction in blood pressure. The total loss of electrolytes can be calculated to about 500mmol sodium, 500mmol potassium, 100mmol phosphate (Table 6) (11). The total loss of electrolytes is not reflected in the levels of potassium and sodium in serum. In many countries the calculation of the anion gap plays a great role in the diagnosis and the therapy of coma diabeticum (AG = [Na+]-[Cl-]-[HCO3-] [mmol/L]). The normal anion gap is between 8 and 16 (e.g., 15=140-100-25). In the case of diabetic ketoacidosis the anion gap is elevated, indicating the presence of other anions like ketone bodies (19).
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