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Title: What is the optimal speed of correction of the hyperosmolar hyperglycemic state in diabetic ketoacidosis? An observational cohort study of USA intensive care patients.
Authors: Blank, Sebastiaan P
Blank, Ruth M
Campbell, Lewis
Citation: Copyright © 2022. Published by Elsevier Inc.
Endocr Pract. 2022 Jun 7:S1530-891X(22)00522-5. doi: 10.1016/j.eprac.2022.06.001.
Abstract: OBJECTIVE: International guidelines for the treatment of diabetic ketoacidosis (DKA) advise against rapid changes in osmolarity and glucose, but the optimal rates of correction are unknown. We aimed to evaluate rates of change in tonicity and glucose in intensive care patients with DKA and their relationship with mortality and altered mental status. METHODS: Observational cohort study using two publicly available databases of USA intensive care patients (Medical Information Mart for Intensive Care-IV and eICU), evaluating adults with DKA and associated hyperosmolarity (baseline Osm≥300mosm/L). The primary outcome was hospital mortality. A secondary neurological outcome used a composite of diagnosed cerebral oedema or Glasgow coma scale ≤12. Multivariable regression models were used to control for confounding factors. RESULTS: On adjusted analysis, those who underwent the most rapid correction of up to approximately 3mmol/L/hr in tonicity had reduced mortality (n=2307, odds ratio (OR) 0.21, overall p<0.001) and adverse neurological outcomes (OR 0.44, p<0.001). Faster correction of glucose levels up to 5mmol/L/hr (90mg/dL/hr) was associated with improvements in mortality (n=2361, OR 0.24, p=0.020) and adverse neurological events (OR 0.52, p=0.046). The number of patients corrected significantly faster than these rates was low. A maximal hourly rate of correction between 2-5mmol/L for tonicity was associated with the lowest mortality rate on adjusted analysis. CONCLUSION: Based on large volume observational data, relatively rapid correction of tonicity and glucose was associated with lower mortality and more favourable neurological outcomes. Avoiding a maximum hourly rate of correction of tonicity >5mmol/L may be advisable.
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Journal title: Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists
Publication Date: 2022-06-07
Type: Journal Article
DOI: 10.1016/j.eprac.2022.06.001
Appears in Collections:(a) NT Health Research Collection

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