At the first visit to our endocrinologist after my daughter was hospitalized for DKA and diagnosed with type 1 diabetes, we were asked to participate in a study to evaluate my daughter’s ability to make insulin. The consent form said the study is designed for children who did not have acidosis at the time of diagnosis. When we raised this to our endocrinologist, he said he thought she wasn’t acidotic at the time of her admission to the hospital, so I am confused. At admittance she had a blood sugar of 695 mg/dl [38.6 mmol/L] and an A1c of 15%. Her admission chemistry profile had out of range readings for CL (93 mg/dl) and CO2 (7mg/dl). How can I tell if she had acidosis? Is DKA the same as being acidotic?

Based on these results, you daughter was acidotic. The cause of her acidosis was DKA [diabetic ketoacidosis].

Why was she acidotic? Because the “C02” (which is carbon dioxide) was low. She was “blowing off” [breathing out with exhaled air] more C02, causing it to be low; the normal C02 is generally 20-24 mg/dl. This low C02 is called a “metabolic acidosis.” There are many causes of metabolic acidosis of which DKA is one. How do I know that this was DKA? Because her glucose was so high! Now strictly speaking, you did not give information as to whether ketones were noted in the blood or urine, but that is a presumption I am willing to make.

So, not all acidosis is DKA, but DKA is an acidosis. The presence of ketones is not the same as acidosis, but this is a spectrum: if uncorrected, hyperglycemia in a person with diabetes will lead to ketone production (ketosis) and eventually, if still uncorrected, to accumulation of more acids as well (“acidosis”). The presence of ketones and acids is ketoacidosis. If diabetes is the fundamental culprit, that is diabetic ketoacidosis (DKA).

I am not familiar with the study that you alluded to but if having DKA was an exclusion to your child’s participation, then based on what you are telling us here, she should have been excluded as she clearly was acidotic.

DS