Salt Depletion, Peripheral Vascular Collapse, and the Treatment of Diabetic Acidosis *

The frequent occurrence of peripheral vascular collapse or shockt in severe diabetic acidosis has long been recognized.3' 5, 6 7, 8 11, 16, 20, 24, 25, 29 The deficit of sodium chloride and water which characterizes diabetic acidosis has been considered to be a causal factor of the shock.20' 22, 24, 25, 29 All programs proposed within recent years for the therapy of severe diabetic acidosis stress the importance of the salt and water deficit by advocating the parenteral administration -of saline. 1, 3, 16, 17, 18, 20, 25, 26, 27 Recently, fatal results in the treatment of diabetic acidosis and coma have been blamed on the early use of glucose, implying that glucose has some undefined toxic action.7 18,27,28 The evidence cited consists mainly of case reports. These reports raise the possibility that the injection of glucose solwtioms, or that glucose per se, may under some circumstances prove harmful. A more precise definition of the respective roles of salt and of water depletion in the etiology of peripheral vascular collapse is now availatble, and the effects of intravenous glucose, saline, and colloid solution in the therapy of shock due to salt depletion have been described.10 12, 32 In a previous analysis the experimental proof in favor of the early use of glucose in diabetic acidosis has been assembled.23 This paper defines the practical role of parenteral saline and glucose solutions in the therapy of diabetic acidosis. The clinical experience of this hospital in the treatment of diabetic acidosis during the past two decades has been analyzed, with particular reference to the incidence of salt and water depletion, shock, and the effects of early administration of glucose.