Evaluation of the Effect of Fluid and Electrolyte Therapy on Electrolytes and Acidosis Resolution Time in Diabetic Ketoacidosis

Öz

Objective: Fluid replacement and insulin infusion are the cornerstones of treatment of diabetic ketoacidosis, but the optimal volume, rate of infusion, and electrolyte content of fluid replacement have been controversial. The aim of this study was to investigate the effects of treatment on pH, bicarbonate (HCO3), anion gap, chloride, and potassium levels as well as time to resolution of acidosis in children with diabetic ketoacidosis. Material and Methods: Ninety-six episodes with diabetic ketoacidosis between January 2015-December 2017 were evaluated. Results: The mean resolution time of acidosis was 13.4±7.1 hours. Anion gap was returned to normal in 68 (70.8%) episodes at the 4th hour of treatment with a mean of 11±4.2 mmol/L. Episodes with potassium phosphate (KPO4) replacement resulted in a faster increase in pH and a significantly shorter resolution time of acidosis (p<0.001). Acidosis persisted at the 16th hour of treatment in episodes with lower pH, lower serum bicarbonate (HCO3) and higher white blood cell (WBC) counts on admission (p<0.001, p=0.003 p=0.033, respectively). Hyperchloremia (Cl/Na ratio > 0.79) was observed in 97% of cases after 8 hours of treatment. Conclusion: Although the value of the anion gap in predicting acidosis is controversial, severe DKA episodes and high white blood cell count at admission; potassium replacement with high amounts of chloride and KCl containing fluids given during treatment have been associated with a longer recovery time of acidosis.

Anahtar Kelimeler

• acidosis
• diabetic ketoacidosis
• hypopotasemia
• pediatric
• Type 1 Diabetes

Diyabetik Ketoasidoz Hastalarında Sıvı ve Elektrolit Tedavisinin Elektrolit Düzeyleri ve Asidoz Düzelme Süresine Etkisi

Öz

Amaç: Sıvı replasmanı ve insülin infüzyonu Diyabetik Ketoasidoz DKA tedavisinin temel taşlarıdır, ancak sıvı replasmanının optimal hacmi, infüzyon hızı ve elektrolit içeriği hala tartışmalı olan bir konudur. Bu çalışmanın amacı, diyabetik ketoasidozlu çocuklarda tedavinin pH, bikarbonat (HCO3), anyon açığı, klorür ve potasyum düzeyleri üzerindeki etkilerinin yanı sıra asidozun düzelme süresini araştırmaktı. Gereç ve Yöntemler: Ocak 2015-Aralık 2017 tarihleri arasında diyabetik ketoasidoz tanısı ile takip edilen 93 hasta (toplam 96 DKA atağı) retrospektif olarak değerlendirildi. Bulgular: Asidozun ortalama düzelme süresi 13.4±7.1 saatti. Anyon açığı 68 (%70.8) atakta tedavinin 4. saatinde ortalama 11±4.2 mmol/L ile normale döndü. Potasyum fosfat (KPO4) replasmanı yapılan hastalarda pH artışı daha hızlı ve asidoz düzelme süresi daha kısa olarak saptandı (p<0.001). Başvuruda daha düşük pH, daha düşük serum bikarbonat (HCO3) ve daha yüksek beyaz küre sayısı olan ataklarda tedavinin 16. saatinde asidozun devam ettiği görüldü (sırasıyla p<0.001, p=0.003 p=0.033). Hiperkloremi (Cl/Na oranı > 0.79) tedavinin 8. saatinde atakların %97’sinde tespit edildi. Sonuç: Asidozu yansıtmada anyon açığının değeri tartışmalı olarak bulunsa da, DKA ataklarının ağır derecede olması ve hastaneye yatışta beyaz kürenin yüksek olması; tedavi sırasında verilen yüksek miktarda klorür ve KCl içeren sıvı ile potasyum replasmanı asidozun daha uzun sürede düzelmesi ile ilişkilendirilmiştir.

Anahtar Kelimeler

• Asidoz
• diyabetik ketoasidoz
• hipopotasemi
• pediatri
• tip 1 diyabet

Kaynakça

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