Diabetic ketoacidosis (DKA) is a complex medical disorder characterized by
abnormalities in
electrolyte,
acid-base, and volume status.
Metabolic acidosis in mild and moderate DKA is corrected with
insulin therapy.
Bicarbonate therapy may be indicated in cases of severe
metabolic acidosis, however the use of
bicarbonate in severe DKA is controversial due to a lack of prospective randomized studies.
Renal replacement therapy can be used for correction of systemic acidemia.
Continuous renal replacement therapy (CRRT) is used in
patients who are too hemodynamically unstable to tolerate conventional
hemodialysis, but has also been used in
treatment of
patients with severe DKA. CRRT has never been used previously in DKA
patients with refractory
metabolic acidosis in
Korea. Here, we describe the successful
treatment of a DKA
patient with refractory
metabolic acidosis with CRRT.