Evaluation of the Relationship Between the Change in Base Excess and Clinical Conditions in Patients with Diabetic Ketoacidosis

Objective: The aim of this study was to evaluate the post-treatment change in base excess (ΔBE) in diabetic ketoacidosis (DKA) and to assess how both the magnitude of correction and the resulting acid–base status relate to presenting severity and routine laboratory parameters.
Material and Methods: We retrospectively analyzed 202 adults presenting with DKA to a tertiary emergency department between 2020 and 2025 who underwent blood gas analysis at presentation and after treatment. ΔBE was defined as post-treatment minus baseline base excess. Comparisons were performed using the Mann–Whitney U and Kruskal–Wallis tests, and associations were assessed using Spearman’s rho.
Results: The median age was 39 years, and 59.9% were male. At presentation, the median pH was 7.08 and HCO₃ was 7.7 mmol/L, indicating marked acidemia. Following treatment, the median ΔBE was 11.9 mmol/L. The magnitude of correction increased with the depth of presenting acidosis (Spearman’s rho=−0.75) and was greater in patients with higher baseline white blood cell counts, glucose, urea, creatinine, and C-reactive protein levels and in those admitted to the intensive care unit versus the ward (16.1 vs 7.8 mmol/L, p<0.001). Although ΔBE differed according to presenting severity (p=0.026), post-treatment base excess was statistically similar across severity strata (p=0.374), indicating that treatment brought patients to a comparable acid–base endpoint regardless of the severity at presentation.
Conclusion: In DKA, the change in base excess following treatment (ΔBE) is a parameter that can be easily derived from laboratory data and is associated with patients’ clinical status.

Keywords: Acidosis, base excess, blood gas analysis, critical care, diabetic ketoacidosis