Evolutive physicochemical characterization of diabetic ketoacidosis in adult patients admitted to the intensive care unit

Lopes, Anselmo Dantas; Maciel, Alexandre Toledo; Park, Marcelo

doi:10.1016/j.jcrc.2010.08.013

Cited by 9 publications

(7 citation statements)

References 25 publications

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“…At paediatric population of critically ill patients, Balasubramanyan et al 5 have indicated that unmeasured anions can be used for lactate values prediction and that they predict mortality rate better than serum lactates. The results of this study support conclusions of other studies which claim that unmeasured anions, detected by the Stewart-Figge's methodology, identify a greater number of patients with acid-base disorders comparing to the conventional parameters (pH, AG, SB, SBE) 1,4,12,18,20,21 . That study proved that initial pH and SBE had the best capability to predict treatment outcome among acid-base variables, while SIG had not significant prognostic power.…”

Section: Discussionsupporting

confidence: 88%

“…It should be mentioned that this study is the first one focused on critically ill patients on mechanical ventilation exclusively, unlike the majority of similar studies 1,5,7,12,16 . It should be mentioned that this study is the first one focused on critically ill patients on mechanical ventilation exclusively, unlike the majority of similar studies 1,5,7,12,16 .…”

Section: Discussionmentioning

confidence: 99%

“…Apparent strong ion difference (SIDapp) is a difference between the sum of all strong cations and strong anions measured 9,10 . 8,[10][11][12][13][14] . The difference between SIDapp and SIDeff measured represents a strong ion gap (SIG) 11 .…”

Section: Introductionmentioning

confidence: 99%

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Prediction of mortality with unmeasured anions in critically ill patients on mechanical ventilation

Novović¹,

Jevđić

2014

VOJNOSANIT PREGL

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

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Prediction of mortality with unmeasured anions in critically ill patients on mechanical ventilation

Novović¹,

Jevđić

2014

VOJNOSANIT PREGL

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“…In terms of quality of the studies, 22 studies31–39,41,42,44,46,49,52–54,56,58,59,61,71 scored poor, 18 studies9,16,21,45,47,48,50,51,60,62,63,66,68–70,72–74 scored fair, and two studies64,65 scored good on NOS. Among studies scoring 5, four 43,55,62,72 were scored on the basis of comparability by controlling confounding factors between the groups as well.…”

Section: Resultsmentioning

confidence: 99%

<p>Correlation of acidosis-adjusted potassium level and cardiovascular outcomes in diabetic ketoacidosis: a systematic review</p>

Usman

Makmor‐Bakry

Mustafa

et al. 2019

DMSO

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Background During the progress and resolution of a diabetic ketoacidosis (DKA) episode, potassium levels are significantly affected by the extent of acidosis. However, none of the current guidelines take into account acidosis during resuscitation of potassium level in DKA management, which may increase the risk of cardiovascular adverse events. Objective To assess literature regarding the adjustment of potassium level using pH to calculate pH-adjusted corrected potassium level, and to observe the relationship of cardiovascular outcomes with reported potassium level and pH-adjusted corrected potassium in DKA. Methodology Seven databases were searched from inception to January 2018 for studies which had reported people with diabetes developing diabetic ketoacidosis, in relation to prevalence or incidence, fluid resuscitation or potassium supplementation treatment, treatment or cardiovascular outcomes, and experimentation with DKA management or insulin. Quality of studies was evaluated using Cochrane Risk of Bias and Newcastle Ottawa Scale. Results Forty-seven studies were included in qualitative synthesis out of a total of 10,292 retrieved studies. Forty-one studies discussed the potassium level and blood pH at the time of admission, ten studies discussed cardiovascular outcomes, and only four studies concurrently discussed potassium level, pH, and cardiovascular outcomes. Only two studies were graded as good on the Newcastle Ottawa Scale. The reported potassium level was well within normal range (5.8 mmol/L), whereas pH rendered patients to be moderately acidotic (7.13). Surprisingly, none of the included studies mentioned pH-adjusted corrected potassium level and, hence, this was calculated later. Although mean corrected potassium was within the normal range (3.56 mmol/L), 13 studies had corrected potassium below 3.5 mmol/L and five had it below 3.0 mmol/L. Nevertheless, with the exception of one study, none discussed cardiovascular outcomes in the context of potassium or pH-adjusted potassium level. Conclusion The evidence surrounding cardiovascular outcomes during DKA episodes in light of a pH-adjusted corrected potassium level is scarce. A prospective observational, or preferably, an experimental study in this regard will ensure we can modify and enhance safety of existing DKA treatment protocols.

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“…[2][3][4][5][6] This consequence could affect outcomes in DKA patients-In fact, 2 studies associated the development of hyperchloremic metabolic acidosis with a delay in the resolution of DKA. 7,8 Given that Plasma-Lyte A (PL) has been shown to prevent the development of hyperchloremic metabolic acidosis in DKA patients compared with NS, the choice of PL as the predominant fluid for resuscitation may lead to quicker resolution of DKA. 9 Only 1 previous study evaluated the question of fluid choice and its effects on the outcomes of patients with DKA.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Plasma-Lyte A and Sodium Chloride 0.9% for Fluid Resuscitation of Patients With Diabetic Ketoacidosis

et al. 2018

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The aim of this study was to compare Plasma-Lyte A (PL) and sodium chloride 0.9% (NS) in regard to time to resolution of diabetic ketoacidosis (DKA) when one fluid was used predominantly over the other for resuscitation. We performed a retrospective analysis of the records of patients treated for DKA at a large, academic medical center between July 1, 2013, and July 1, 2015. Patients were placed into the PL or NS group based on the predominant fluid they received during fluid resuscitation. Serum biochemistry variables were categorized as follows: initial, 2 to 4 hours, 4 to 6 hours, 6 to 12 hours, and 12 to 24 hours. The primary outcome was mean time to resolution of DKA. Eighty-four patients were included in the study. The primary outcome of mean time to resolution of DKA was similar between the PL (19.74 hours) and NS (18.05 hours) groups ( = .5080). Patients treated with PL had a significantly greater rise in pH within the 4- to 6-hour and 6- to 12-hour periods. The chloride level was significantly higher and the anion gap was significantly lower for the NS group in the 6- to 12-hour period. These data suggest that the use of PL for fluid resuscitation in DKA may confer certain advantages over NS.

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Evolutive physicochemical characterization of diabetic ketoacidosis in adult patients admitted to the intensive care unit

Cited by 9 publications

References 25 publications

Prediction of mortality with unmeasured anions in critically ill patients on mechanical ventilation

Prediction of mortality with unmeasured anions in critically ill patients on mechanical ventilation

<p>Correlation of acidosis-adjusted potassium level and cardiovascular outcomes in diabetic ketoacidosis: a systematic review</p>

Comparison of Plasma-Lyte A and Sodium Chloride 0.9% for Fluid Resuscitation of Patients With Diabetic Ketoacidosis

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