Hidoc Bulletin

Diabetic ketoacidosis (DKA) is one of the serious acute complications observed in diabetes. An elevation of capillary blood glucose, apillary ketones and other parameters like elevation of positive urine ketones, venous pH, bicarbonate are noted in DKA. In order to anage such severe diseases approaches like fluid and potassium replacement, intravenous insulin infusion, intensive monitoring and targeted investigation are done. Fluid therapy has been observed to play an important role in treating Diabetic Ketoacidosis because of the substantial fluid loss occurring due to osmotic diuresis but the ideal fluid for treating diabetic ketoacidosis is still unknown and is also a controversial topic.

In the majority of the cases, it is noted that 0.9% solution of sodium chloride is used in order to overcome the fluid deficit. However,it has been proposed that use of Sterofundin ISO can have a positive impact in controlling acidosis. Sterofundin ISO is a solution which can be used to infuse into the vein when the blood has become slightly acidic. Thus, it is expected that using the Sterofundin ISO as an alternative crystalloid can help in dealing with the event of acidosis in DKA. 

In order to understand the same, a study has been referred which has the aim of comparing the rate of acidosis resolution using 0.9% Normal Saline and Sterofundin among the patients of Diabetic Ketoacidosis over a period of 12 hrs. The study has also examined the strong ion difference, clearance of blood ketones in 12 hrs and electrolyte balance between the two groups. To achieve it, samples of 18 DKA patients are taken and divided into two groups who received 0.9% of NS and Sterofundin respectively. The parameters of strong ion difference, blood ketone and electrolytes (Sodium, Potassium, and Calcium) are properly monitored among them over the period of 12 hrs. The study indicated that the level of chloride in the group of patients receiving NS has an increasing trend compared to the Sterofundin group. Further, the event of ketone clearance occurred more rapidly in the Sterofundin group. Reduction in anion gap found to be higher in the Sterofundin group and an important thing noted regarding Sterofundin is that it does not allow to increase the potassium level in serum thus preventing the occurrence of hypokalemia among the patients. But all these events are noted in the earlier phase only. 

The overall study proposal and results can help in determining the noticeable difference observed in the DKA patients who received Sterofundin and normal saline respectively. An earlier acidosis reversal, rapid reduction of anion gap and prevention of potassium depletion observed among the patients receiving Sterofundin infusion. However, considering the patient's condition for 6 months, the result failed to show the significant difference in the parameters of blood ketones, anion gap reduction, bicarbonate normalization, sodium, chloride, urea and creatinine. Also there are no significant changes in the rates of mortality and morbidity and thus, the topic still remains a question for future studies.Diabetic ketoacidosis (DKA) is one of the serious acute complications observed in diabetes. An elevation of capillary blood glucose, capillary ketones and other parameters like elevation of positive urine ketones, venous pH, bicarbonate are noted in DKA. In order to manage such severe diseases approaches like fluid and potassium replacement, intravenous insulin infusion, intensive monitoring and targeted investigation are done. Fluid therapy has been observed to play an important role in treating Diabetic Ketoacidosis because of the substantial fluid loss occurring due to osmotic diuresis but the ideal fluid for treating diabetic ketoacidosis is still unknown and is also a controversial topic. 

In the majority of the cases, it is noted that 0.9% solution of sodium chloride is used in order to overcome the fluid deficit. However, it has been proposed that use of Sterofundin ISO can have a positive impact in controlling acidosis. Sterofundin ISO is a solution which can be used to infuse into the vein when the blood has become slightly acidic. Thus, it is expected that using the Sterofundin SO as an alternative crystalloid can help in dealing with the event of acidosis in DKA. 

In order to understand the same, a study has been referred which has the aim of comparing the rate of acidosis resolution using 0.9% Normal Saline and Sterofundin among the patients of Diabetic Ketoacidosis over a period of 12 hrs. The study has also examined the strong ion difference, clearance of blood ketones in 12 hrs and electrolyte balance between the two groups. To achieve it, samples of 18 DKA patients are taken and divided into two groups who received 0.9% of NS and Sterofundin respectively. The parameters of strong ion difference, blood ketone and electrolytes (Sodium, Potassium, and Calcium) are properly monitored among them over the period of 12 hrs. The study indicated that the level of chloride in the group of patients receiving NS has an increasing trend compared to the Sterofundin group. Further, the event of ketone clearance occurred more rapidly in the Sterofundin group. Reduction in anion gap found to be higher in the Sterofundin group and an important thing noted regarding Sterofundin is that it does not allow to increase the potassium level in serum thus preventing the occurrence of hypokalemia among the patients. But all these events are noted in the earlier phase only.

The overall study proposal and results can help in determining the noticeable difference observed in the DKA patients who received Sterofundin and normal saline respectively. An earlier acidosis reversal, rapid reduction of anion gap and prevention of potassium depletion observed among the patients receiving Sterofundin infusion. However, considering the patient's condition for 6 months, the result failed to show the significant difference in the parameters of blood ketones, anion gap reduction, bicarbonate normalization, sodium, chloride, urea and creatinine. Also there are no significant changes in the rates of mortality and morbidity and thus, the topic still remains a question for future studies.