The mechanism of hyperchloremic acidosis during the recovery phase of diabetic ketoacidosis

IMPORTANCE: Fluid replacement to correct dehydration, acidosis and electrolyte abnormalities is the cornerstone of treatment for diabetic ketoacidosis (DKA) but little is known about optimal fluid infusion rates and electrolyte content. OBJECTIVE: <a>To</a> evaluate whether different fluid protocols affect the rate of normalization of biochemical derangements during DKA treatment. DESIGN, SETTING, PaRTICIPANTS: The current analysis involved moderate or severe DKA episodes (n=714) in children <18 years enrolled in the Fluid Therapies Under Investigation in DKA (FLUID) Trial. INTERVENTION: Children were assigned to one of four treatment groups using a 2-by-2 factorial design (0.90% or 0.45% saline and fast or slow rate of administration). Results: The rate of change of pH did not differ by treatment arm, but PCO2 increased more rapidly in the fast vs slow fluid infusion arms during the initial 4 hours of treatment. The anion gap also decreased more rapidly in the fast vs slow infusion arms during the initial 4 and 8 hours. Glucose-corrected sodium levels remained stable in patients assigned to 0.90% saline but decreased in those assigned to 0.45% saline at 4 and 8 hours. Potassium levels decreased, while chloride levels increased more rapidly with 0.90% vs 0.45% saline. Hyperchloremic acidosis occurred more frequently in patients in the fast arms (46.1%) vs slow arms (35.2%). <h4>CONCLUSIONS AND RELEVANCE: In children treated for DKA, faster fluid administration rates led to a more rapid normalization of anion gap and PCO2 than slower fluid infusion rates but were associated with an increased frequency of hyperchloremic acidosis. </h4>

Download Full-text

Cardiac Arrest Related to Torsades de Pointes in a Patient Recovering from Diabetic Ketoacidosis

Korean Journal of Medicine ◽

10.3904/kjm.2021.96.5.432 ◽

2021 ◽

Vol 96 (5) ◽

pp. 432-437

Author(s):

Jinmo Kim ◽

Ju Yeop Lee ◽

Won Sang Yoo ◽

Myung Yong Lee ◽

Hyun-Kyung Chung

Keyword(s):

Diabetic Ketoacidosis ◽

Qt Interval ◽

Clinical Course ◽

Structural Heart Disease ◽

Torsades De Pointes ◽

Recovery Phase ◽

Qt Prolongation ◽

Polymorphic Ventricular Tachycardia ◽

Appropriate Therapy ◽

Prolonged Qt Interval

Diabetic ketoacidosis (DKA) is an acute complication related to severe hyperglycemia. While the mortality rate for DKA is low with appropriate therapy, several complications may lead to deterioration of the clinical course. Here, we report a case of a 23-year-old patient with DKA who suffered from a rare but hemodynamically unstable cardiac arrhythmia, polymorphic ventricular tachycardia with prolonged QT interval, or Torsades de Pointes. During the recovery phase of DKA, three episodes of Torsades de Pointes suddenly occurred, and were recovered by immediate defibrillation. The patient did not have structural heart disease or a genetic predisposition. To the best of our knowledge, this is the first report of an adult with DKA complicated with QT prolongation related to Torsades de Points after correction of ketosis. To manage DKA, more attention may be needed on changes in the QT interval as well as risk factors for Torsades de Points.

Download Full-text