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Acidosis and Coma in Juvenile Diabetics

Acidosis and Coma in Juvenile Diabetics Abstract From published reports, including this one, it might be concluded that the formerly high death rate from acidosis and coma in juvenile diabetics1-3 is reaching the vanishing point.4-11 Such complacency is unjustified. Diabetes mellitus is the eighth cause of death in the 1- to 14-year age group,12 and, though specific diagnoses are not available, it is highly probable that almost all of these deaths occur in acidosis and coma. These isolated fatalities, largely unreported in the pediatric literature, account for the bulk of more than 3000 deaths recorded during the past decade.13 It is reasonable to presume that such deaths are largely preventable. We have reviewed our series of acidosis and coma for principles that might be applicable to these fatalities. Materials and Methods Criteria for the diagnosis of diabetic ketosis, acidosis, and coma vary.4-6,10,14,15 To provide objective standards for comparison, we divide our cases References 1. Owens, L. B., and Rockwern, S. S.: Prognosis in Diabetic Coma: Basic Importance of Mental State , Am. J. M. Sc. 198:252, 1939.Crossref 2. Harwood, R.: Diabetic Acidosis: Results of Treatment in 67 Consecutive Cases , New England J. Med. 245:1, 1951.Crossref 3. Collen, M. F.: Mortality in Diabetic Coma , Arch. Int. Med. 70:347, 1942.Crossref 4. Joslin, E. P.; Root, H. F.; White, P.; Marble, A., and Hunt, H. M.: Diabetic Coma , M. Clin. North America 16:793, 1932. 5. Joslin, E. P.; Root, H. F.; White, P.; Marble, A., and Joslin, A. P.: Diabetic Coma , Arch. Int. Med 59:175, 1937.Crossref 6. Joslin, E. P.; Root, H. F.; White, P., and Marble, A.: Diabetic Coma , J.A.M.A. 119:1160, 1942.Crossref 7. Bowen, B. D., and Hekimian, I.: Diabetic Coma: A Report of 81 Instances , Ann. Int. Med. 3:1111, 1930.Crossref 8. Baker, T. W.: A Clinical Survey of 108 Consecutive Cases of Diabetic Coma , Arch. Int. Med. 58:373, 1936.Crossref 9. Hagtvet, J.: Diabetic Coma: A 9 Year Statistical Record , Acta med. scandinav. 114:168, 1943.Crossref 10. Dillon, E. S., and Dyer, W. W.: Factors Influencing the Prognosis in Diabetic Coma , Ann. Int. Med. 11:602, 1937.Crossref 11. Beardwood, J. T., Jr., and Rouse, G. P., Jr.: Diabetic Acidosis: A Study of 220 Consecutive Cases , J.A.M.A. 117:1701, 1941.Crossref 12. Monthly Vital Statistics Report, United States Department of Health, Education, and Welfare, Public Health Service , National Office of Vital Statistics 3:16, 1955. 13. Vital Statistics, Special Reports, National Summaries, Death and Death Rates for Selected Causes by Age, Race, and Sex, United States, Federal Security Agency, Public Health Service, National Office Vital Statistics 29:19, 23, 1948 14. 31:125, 139, 1949 15. 35:325, 339, 1950 16. 38:68, 74, 1954 17. 37:297, 317, 1953 18. 40:6, 12, 1954 19. 42:66, 1955. 20. Joslin, E. P.: Diabetic Coma , Pennsylvania M. J. 56:353, 1953. 21. Sprague, R. G.: Diabetic Acidosis and Coma , M. Clin. North America 31:445, 1947. 22. Adams, S. F.: The Seasonal Variation in the Onset of Acute Diabetes: Age and Sex Factors in 1000 Diabetic Patients , Arch. Int. Med. 37:861, 1926.Crossref 23. Spencer, H.: Diabetes Mellitus in Children: Studies of the Height and Weight of 45 Patients , Am. J. Dis. Child. 36:502, 1928.Crossref 24. Nelson, W. E.: Textbook of Pediatrics , Philadelphia, W. B. Saunders Company, 1954, pp. 1275-1286. 25. Danowski, T. S.: Diabetes Mellitus, with Emphasis on Children and Young Adults , Baltimore, Williams & Wilkins Company, 1957, Chaps. 18 , 19, and 20. 26. Talbot, N. B.; Crawford, J. D., and Butler, A. M.: Medical Progress: Homeostatic Limits to Safe Parenteral Fluid Therapy , New England J. Med. 248:1100, 1953.Crossref 27. Elkinton, J. R., and Danowski, T. S.: The Body Fluids: Basic Physiology and Practical Therapeutics , Baltimore, Williams and Wilkins Company, 1955, Chap. 4 . 28. Danowski, T. S.; Peters, J. H.; Rathbun, J. C.; Quashnock, J. M., and Greenman, L.: Studies in Diabetic Acidosis and Coma, with Particular Emphasis on Retention of Administered Potassium , J. Clin. Invest. 28:1, 1949.Crossref 29. Greenman, L.; Mateer, F. M.; Gow, R. C.; Peters, J. H., and Danowski, T. S.: Some Observations on Development of Hypokaliemia During Therapy of Diabetic Acidosis in Juvenile and Young Adult Subjects , J. Clin. Invest. 28:409, 1949.Crossref 30. Danowski, T. S.; Greenman, L.; Mateer, F. M.; Parsons, W. B.; Weigand, F. A.; Mermelstein, H., and Peters, J. H.: Carboxylic Cation Exchange Resin Effects in Dogs , J. Clin. Invest. 30:984, 1951.Crossref 31. Butler, A. M.; Talbot, N. B.; Burnett, C. H.; Stanbury, J. B., and MacLachlan, E. A.: Metabolic Studies in Diabetic Coma , Tr. A. Am. Physicians 60:102, 1947. 32. Darrow, D. C., and Pratt, E. L.: Retention of Water and Electrolyte During Recovery in a Patient with Diabetic Acidosis , J. Pediat. 41:688, 1952.Crossref 33. Singer, R. B., and Hastings, A.B.: Improved Clinical Method for Estimation of Disturbances of Acid-Base Balance of Human Blood , Medicine 27:223, 1948.Crossref 34. Bock, A. V.; Field, H., Jr., and Adair, G. S.: Acid-Base Equilibrium in Diabetic Coma, Being a Study of 5 Cases Treated with Insulin , J. Metabolic Res. 4:27, 1923. 35. Butler, A. M.: Medical Progress: Diabetic Coma , New England J. Med. 243:648, 1950.Crossref 36. Kerrigan, G. A.; Crawford, J. D.; Sceery, R. T.; Heeley, A.; Terry, M., and Talbot, N. B.: Concerning Importance of Homeostatic Systems in Recovery of Patients Requiring Parenteral Fluid Therapy , Society Transactions, A. M. A. Am. J. Dis. Child. 86:622, 1953. 37. Talbot, N. B.; Sobel, E. H.; McArthur, J. W., and Crawford, J. D.: Functional Endocrinology, from Birth Through Adolescence , Cambridge, Mass., Harvard University Press, 1952, pp. 597. 38. Danowski, T. S.; Winkler, A. W., and Peters, J. P.: Salt Depletion, Peripheral Vascular Collapse, and Treatment of Diabetic Acidosis , Yale J. Biol. Med. 18:405, 1946. 39. Winkler, A. W.; Danowski, T. S., and Elkinton, J. R.: Role of Colloid and of Saline in Treatment of Shock , J. Clin. Invest. 25:220, 1946.Crossref 40. Root, H. F.: Anuria Following Diabetic Coma Relieved by Hypertonic Salt Solution , J.A.M.A. 103:482, 1934.Crossref 41. Root, H. F.: Use of Glucose in Treatment of Diabetic Coma , J. Clin. Endocrinol. 5:353, 1945.Crossref 42. Soskin, S., and Levine, R.: Physiological and Clinical Aspects of Ketosis , Am. J. Digest. Dis. 11:305, 1944.Crossref 43. Bondy, P. K.; Sheldon, W. H., and Evans, L. D.: Changes in Liver Glycogen Studied by Needle Aspiration Technic in Patients with Diabetic Ketosis, with Method for Estimation of Glycogen from Histologic Preparations , J. Clin. Invest. 28: 1216, 1949.Crossref 44. Bondy, P. K., and Sheldon, W. H.: Histochemical Demonstration of Liver Glycogen in Human Diabetic Acidosis by Liver Biopsy , Proc. Soc. Exper. Biol. & Med. 65:68, 1947. 45. Danowski, T. S.; Winkler, A. W., and Elkinton, J. R.: The Treatment of Shock Due to Salt Depletion: Comparison of the Hemodynamic Effects of Isotonic Saline, of Hypertonic Saline, and of Isotonic Glucose Solutions , J. Clin. Invest. 25:130, 1946. 46. Danowski, T. S.; Winkler, A. W., and Elkinton, J. R.: Biochemical and Hemodynamic Changes Following Subcutaneous Injection of Glucose Solution , J. Clin. Invest. 26:887, 1947. 47. Moncrief, J. A.; Coldwater, K. B., and Elman, R.: Postoperative Loss of Sugar in Urine Following Intravenous Infusion of Fructose (Levulose) , A. M. A. Arch. Surg. 67:57, 1953. 48. Miller, M.; Drucker, W. R.; Owens, J. E.; Craig, J. W., and Woodward, H., Jr.: Comparison of Metabolic Effects of Fructose and Glucose Administered Intravenously to Normal and Diabetic Subjects , J. Lab. & Clin. Med. 38:931, 1951. 49. Miller, M.; Murphy, J. R.; Craig, J. W., and Woodward, H., Jr.: Studies in Experimental Diabetic Acidosis: Comparison of Effect of Fructose and Glucose in Initial Hours of Treatment , J. Clin. Endocrinol. 13:866, 1953. 50. Darragh, J. H.; Womersley, R. A., and Meroney, W. H.: Fructose in Treatment of Diabetic Ketosis, J. Clin. Invest. 32:1214, 1953. 51. Klinger, R., and Dalle Coste, P.: Use of Fructose in Diet and Treatment of Patients with Diabetes Mellitus , Minerva med. 46:1389, 1955. 52. Dolger, H.; Kupfer, S.; Bookman, J. J., and Carr, J.: Intravenous Fructose in Diabetes Mellitus: Advantages Over Glucose in the Treatment of Diabetic Emergencies , J. Clin. Invest. 32:562, 1953. 53. Seltzer, H. S., and Conn, J. W.: Fructose Metabolism in Diabetes: Clinical Applications , J. Michigan M. Soc. 52:1095, 1953. 54. McArthur, J. W.; Smart, G. A.; MacLachlan, E. A.; Terry, M. L.; Harting, D.; Gautier, E.; Godley, A.; Swallow, K. A.; Simeone, F. A.; Zygmuntowicz, A.; Christo, E.; Crepeaux, J.; Point, W. W., and Benson, J. A., Jr.: Studies Concerning Role of Adrenal Cortex in Pathologic Physiology of Diabetic Acidosis: Temporal Relations Between Metabolic Events of Experimental Diabetic Acidosis and Level of Adrenal Cortical Function , J. Clin. Invest. 33:420, 1954.Crossref 55. Greenman, L.; Danowski, T. S.; Rosenbloom, M., and Holt, J.: 17-Ketosteroid Excretion During Therapy of Diabetic Acidosis , Fed. Proc. 10:55, 1951. 56. Tagnon, R. F., and Devreux, S.: Effect of Intravenous Injection of Fructose, With and Without ACTH Administration, on the Level of Blood Glucose , J. Clin. Endocrinol. 15:1475, 1955.Crossref 57. Wick, A. N.; Sherrill, J. W., and Drury, D. R.: The Metabolism of Fructose by the Extrahepatic Tissues , Diabetes 2:465, 1953. 58. Guest, G. M.: Organic Phosphates of Blood and Mineral Metabolism in Diabetic Acidosis: President's Address , Am. J. Dis. Child. 64:401, 1942.Crossref 59. Franks, M.; Berris, R. F., and Kaplan, N. O.: Phosphorus Metabolism in Diabetic Coma , J. Clin. Invest. 25:923, 1946. 60. Danowski, T. S.; Hald, P. M., and Peters, J. P.: Sodium, Potassium and Phosphates in Cells and Serum of Blood in Diabetic Acidosis , Am. J. Physiol. 149:667, 1947. 61. Franks, M.; Berris, R. F.; Kaplan, N. O., and Myers, G. B.: Metabolic Studies in Diabetic Acidosis: II. Effect of Administration of Sodium Phosphate , Arch. Int. Med. 81:42, 1948.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png A.M.A. Journal of Diseases of Children American Medical Association

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Copyright © 1957 American Medical Association. All Rights Reserved.
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0096-6916
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Abstract

Abstract From published reports, including this one, it might be concluded that the formerly high death rate from acidosis and coma in juvenile diabetics1-3 is reaching the vanishing point.4-11 Such complacency is unjustified. Diabetes mellitus is the eighth cause of death in the 1- to 14-year age group,12 and, though specific diagnoses are not available, it is highly probable that almost all of these deaths occur in acidosis and coma. These isolated fatalities, largely unreported in the pediatric literature, account for the bulk of more than 3000 deaths recorded during the past decade.13 It is reasonable to presume that such deaths are largely preventable. We have reviewed our series of acidosis and coma for principles that might be applicable to these fatalities. Materials and Methods Criteria for the diagnosis of diabetic ketosis, acidosis, and coma vary.4-6,10,14,15 To provide objective standards for comparison, we divide our cases References 1. Owens, L. B., and Rockwern, S. S.: Prognosis in Diabetic Coma: Basic Importance of Mental State , Am. J. M. Sc. 198:252, 1939.Crossref 2. Harwood, R.: Diabetic Acidosis: Results of Treatment in 67 Consecutive Cases , New England J. Med. 245:1, 1951.Crossref 3. Collen, M. F.: Mortality in Diabetic Coma , Arch. Int. Med. 70:347, 1942.Crossref 4. Joslin, E. P.; Root, H. F.; White, P.; Marble, A., and Hunt, H. M.: Diabetic Coma , M. Clin. North America 16:793, 1932. 5. Joslin, E. P.; Root, H. F.; White, P.; Marble, A., and Joslin, A. P.: Diabetic Coma , Arch. Int. Med 59:175, 1937.Crossref 6. Joslin, E. P.; Root, H. F.; White, P., and Marble, A.: Diabetic Coma , J.A.M.A. 119:1160, 1942.Crossref 7. Bowen, B. D., and Hekimian, I.: Diabetic Coma: A Report of 81 Instances , Ann. Int. Med. 3:1111, 1930.Crossref 8. Baker, T. W.: A Clinical Survey of 108 Consecutive Cases of Diabetic Coma , Arch. Int. Med. 58:373, 1936.Crossref 9. Hagtvet, J.: Diabetic Coma: A 9 Year Statistical Record , Acta med. scandinav. 114:168, 1943.Crossref 10. Dillon, E. S., and Dyer, W. W.: Factors Influencing the Prognosis in Diabetic Coma , Ann. Int. Med. 11:602, 1937.Crossref 11. Beardwood, J. T., Jr., and Rouse, G. P., Jr.: Diabetic Acidosis: A Study of 220 Consecutive Cases , J.A.M.A. 117:1701, 1941.Crossref 12. Monthly Vital Statistics Report, United States Department of Health, Education, and Welfare, Public Health Service , National Office of Vital Statistics 3:16, 1955. 13. Vital Statistics, Special Reports, National Summaries, Death and Death Rates for Selected Causes by Age, Race, and Sex, United States, Federal Security Agency, Public Health Service, National Office Vital Statistics 29:19, 23, 1948 14. 31:125, 139, 1949 15. 35:325, 339, 1950 16. 38:68, 74, 1954 17. 37:297, 317, 1953 18. 40:6, 12, 1954 19. 42:66, 1955. 20. Joslin, E. P.: Diabetic Coma , Pennsylvania M. J. 56:353, 1953. 21. Sprague, R. G.: Diabetic Acidosis and Coma , M. Clin. North America 31:445, 1947. 22. Adams, S. F.: The Seasonal Variation in the Onset of Acute Diabetes: Age and Sex Factors in 1000 Diabetic Patients , Arch. Int. Med. 37:861, 1926.Crossref 23. Spencer, H.: Diabetes Mellitus in Children: Studies of the Height and Weight of 45 Patients , Am. J. Dis. Child. 36:502, 1928.Crossref 24. Nelson, W. E.: Textbook of Pediatrics , Philadelphia, W. B. Saunders Company, 1954, pp. 1275-1286. 25. Danowski, T. S.: Diabetes Mellitus, with Emphasis on Children and Young Adults , Baltimore, Williams & Wilkins Company, 1957, Chaps. 18 , 19, and 20. 26. Talbot, N. B.; Crawford, J. D., and Butler, A. M.: Medical Progress: Homeostatic Limits to Safe Parenteral Fluid Therapy , New England J. Med. 248:1100, 1953.Crossref 27. Elkinton, J. R., and Danowski, T. S.: The Body Fluids: Basic Physiology and Practical Therapeutics , Baltimore, Williams and Wilkins Company, 1955, Chap. 4 . 28. Danowski, T. S.; Peters, J. H.; Rathbun, J. C.; Quashnock, J. M., and Greenman, L.: Studies in Diabetic Acidosis and Coma, with Particular Emphasis on Retention of Administered Potassium , J. Clin. Invest. 28:1, 1949.Crossref 29. Greenman, L.; Mateer, F. M.; Gow, R. C.; Peters, J. H., and Danowski, T. S.: Some Observations on Development of Hypokaliemia During Therapy of Diabetic Acidosis in Juvenile and Young Adult Subjects , J. Clin. Invest. 28:409, 1949.Crossref 30. Danowski, T. S.; Greenman, L.; Mateer, F. M.; Parsons, W. B.; Weigand, F. A.; Mermelstein, H., and Peters, J. H.: Carboxylic Cation Exchange Resin Effects in Dogs , J. Clin. Invest. 30:984, 1951.Crossref 31. Butler, A. M.; Talbot, N. B.; Burnett, C. H.; Stanbury, J. B., and MacLachlan, E. A.: Metabolic Studies in Diabetic Coma , Tr. A. Am. Physicians 60:102, 1947. 32. Darrow, D. C., and Pratt, E. L.: Retention of Water and Electrolyte During Recovery in a Patient with Diabetic Acidosis , J. Pediat. 41:688, 1952.Crossref 33. Singer, R. B., and Hastings, A.B.: Improved Clinical Method for Estimation of Disturbances of Acid-Base Balance of Human Blood , Medicine 27:223, 1948.Crossref 34. Bock, A. V.; Field, H., Jr., and Adair, G. S.: Acid-Base Equilibrium in Diabetic Coma, Being a Study of 5 Cases Treated with Insulin , J. Metabolic Res. 4:27, 1923. 35. Butler, A. M.: Medical Progress: Diabetic Coma , New England J. Med. 243:648, 1950.Crossref 36. Kerrigan, G. A.; Crawford, J. D.; Sceery, R. T.; Heeley, A.; Terry, M., and Talbot, N. B.: Concerning Importance of Homeostatic Systems in Recovery of Patients Requiring Parenteral Fluid Therapy , Society Transactions, A. M. A. Am. J. Dis. Child. 86:622, 1953. 37. Talbot, N. B.; Sobel, E. H.; McArthur, J. W., and Crawford, J. D.: Functional Endocrinology, from Birth Through Adolescence , Cambridge, Mass., Harvard University Press, 1952, pp. 597. 38. Danowski, T. S.; Winkler, A. W., and Peters, J. P.: Salt Depletion, Peripheral Vascular Collapse, and Treatment of Diabetic Acidosis , Yale J. Biol. Med. 18:405, 1946. 39. Winkler, A. W.; Danowski, T. S., and Elkinton, J. R.: Role of Colloid and of Saline in Treatment of Shock , J. Clin. Invest. 25:220, 1946.Crossref 40. Root, H. F.: Anuria Following Diabetic Coma Relieved by Hypertonic Salt Solution , J.A.M.A. 103:482, 1934.Crossref 41. Root, H. F.: Use of Glucose in Treatment of Diabetic Coma , J. Clin. Endocrinol. 5:353, 1945.Crossref 42. Soskin, S., and Levine, R.: Physiological and Clinical Aspects of Ketosis , Am. J. Digest. Dis. 11:305, 1944.Crossref 43. Bondy, P. K.; Sheldon, W. H., and Evans, L. D.: Changes in Liver Glycogen Studied by Needle Aspiration Technic in Patients with Diabetic Ketosis, with Method for Estimation of Glycogen from Histologic Preparations , J. Clin. Invest. 28: 1216, 1949.Crossref 44. Bondy, P. K., and Sheldon, W. H.: Histochemical Demonstration of Liver Glycogen in Human Diabetic Acidosis by Liver Biopsy , Proc. Soc. Exper. Biol. & Med. 65:68, 1947. 45. Danowski, T. S.; Winkler, A. W., and Elkinton, J. R.: The Treatment of Shock Due to Salt Depletion: Comparison of the Hemodynamic Effects of Isotonic Saline, of Hypertonic Saline, and of Isotonic Glucose Solutions , J. Clin. Invest. 25:130, 1946. 46. Danowski, T. S.; Winkler, A. W., and Elkinton, J. R.: Biochemical and Hemodynamic Changes Following Subcutaneous Injection of Glucose Solution , J. Clin. Invest. 26:887, 1947. 47. Moncrief, J. A.; Coldwater, K. B., and Elman, R.: Postoperative Loss of Sugar in Urine Following Intravenous Infusion of Fructose (Levulose) , A. M. A. Arch. Surg. 67:57, 1953. 48. Miller, M.; Drucker, W. R.; Owens, J. E.; Craig, J. W., and Woodward, H., Jr.: Comparison of Metabolic Effects of Fructose and Glucose Administered Intravenously to Normal and Diabetic Subjects , J. Lab. & Clin. Med. 38:931, 1951. 49. Miller, M.; Murphy, J. R.; Craig, J. W., and Woodward, H., Jr.: Studies in Experimental Diabetic Acidosis: Comparison of Effect of Fructose and Glucose in Initial Hours of Treatment , J. Clin. Endocrinol. 13:866, 1953. 50. Darragh, J. H.; Womersley, R. A., and Meroney, W. H.: Fructose in Treatment of Diabetic Ketosis, J. Clin. Invest. 32:1214, 1953. 51. Klinger, R., and Dalle Coste, P.: Use of Fructose in Diet and Treatment of Patients with Diabetes Mellitus , Minerva med. 46:1389, 1955. 52. Dolger, H.; Kupfer, S.; Bookman, J. J., and Carr, J.: Intravenous Fructose in Diabetes Mellitus: Advantages Over Glucose in the Treatment of Diabetic Emergencies , J. Clin. Invest. 32:562, 1953. 53. Seltzer, H. S., and Conn, J. W.: Fructose Metabolism in Diabetes: Clinical Applications , J. Michigan M. Soc. 52:1095, 1953. 54. McArthur, J. W.; Smart, G. A.; MacLachlan, E. A.; Terry, M. L.; Harting, D.; Gautier, E.; Godley, A.; Swallow, K. A.; Simeone, F. A.; Zygmuntowicz, A.; Christo, E.; Crepeaux, J.; Point, W. W., and Benson, J. A., Jr.: Studies Concerning Role of Adrenal Cortex in Pathologic Physiology of Diabetic Acidosis: Temporal Relations Between Metabolic Events of Experimental Diabetic Acidosis and Level of Adrenal Cortical Function , J. Clin. Invest. 33:420, 1954.Crossref 55. Greenman, L.; Danowski, T. S.; Rosenbloom, M., and Holt, J.: 17-Ketosteroid Excretion During Therapy of Diabetic Acidosis , Fed. Proc. 10:55, 1951. 56. Tagnon, R. F., and Devreux, S.: Effect of Intravenous Injection of Fructose, With and Without ACTH Administration, on the Level of Blood Glucose , J. Clin. Endocrinol. 15:1475, 1955.Crossref 57. Wick, A. N.; Sherrill, J. W., and Drury, D. R.: The Metabolism of Fructose by the Extrahepatic Tissues , Diabetes 2:465, 1953. 58. Guest, G. M.: Organic Phosphates of Blood and Mineral Metabolism in Diabetic Acidosis: President's Address , Am. J. Dis. Child. 64:401, 1942.Crossref 59. Franks, M.; Berris, R. F., and Kaplan, N. O.: Phosphorus Metabolism in Diabetic Coma , J. Clin. Invest. 25:923, 1946. 60. Danowski, T. S.; Hald, P. M., and Peters, J. P.: Sodium, Potassium and Phosphates in Cells and Serum of Blood in Diabetic Acidosis , Am. J. Physiol. 149:667, 1947. 61. Franks, M.; Berris, R. F.; Kaplan, N. O., and Myers, G. B.: Metabolic Studies in Diabetic Acidosis: II. Effect of Administration of Sodium Phosphate , Arch. Int. Med. 81:42, 1948.Crossref

Journal

A.M.A. Journal of Diseases of ChildrenAmerican Medical Association

Published: Apr 1, 1957

References