METABOLIC ACIDOSIS is a clinical state characterized by an excess of hydrogen ions, the source of which are acids other than carbonic. In diabetic acidosis, the source of the excessive hydrogen ion is ketoacids formed during the process of intermediary metabolism in the absence of insulin. The degree of acidemia, ie, lowering of arterial blood pH, will depend on the severity of the metabolic disturbance on the one hand and the efficiency of the compensating mechanisms on the other. Reductions in arterial blood acid-base parameters, pH, [HCO3—], and Pco2, define the pattern of the metabolic acidosis. Reduction in Pco2 is a reflection of the compensatory hyperventilation (Kussmaul respiration) occurring presumably in response to the lowered pH. If untreated, diabetic acidosis is fatal.
Stadelmann 2 in 1883 was the first to recognize that the symptom complex of diabetic coma was similar to the acid intoxication produced in rabbits by Walter.3