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.