Figure 624

Diabetic ketoacidosis (DKA) and nonketotic hyperglycemia (NKH) management. Administration of insulin is the cornerstone of management for both DKA and NKH. Replacement of the prevailing water, sodium, and potassium deficits is also required. Alkali are administered only under certain circumstances in DKA and virtually never in

NKH, in which ketoacidosis is generally absent. Because the fluid deficit is generally severe in patients with NKH, many of whom have preexisting heart disease and are relatively old, safe fluid replacement may require monitoring of central venous pressure, pulmonary capillary wedge pressure, or both [1,17,18].

Renal tubular acidosis

Feature

Proximal RTA

Classic Distal RTA

Hyperkalemic Distal RTA

Plasma bicarbonate

14-18 mEq/L

Variable, may be

15-20 mEq/L

ion concentration

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