Abstract：
OBJECTIVE: The effectiveness of standard treatment for diabetic ketoacidosis (DKA) in \"euglycemic DKA\" (EuDKA, blood glucose (BG) ≤ 250 mg/dL) was evaluated with respect to the time to correction of BG ≤ 200 mg/dL, anion gap (AG)≤12 mmol/L, and serum bicarbonate [HCO3] ≥18 mmol/L.
METHODS: Data were retrieved from an electronic health record (EPIC) for \"diabetic ketoacidosis.\" Patients were categorized by initial BG as EuDKA, middle range DKA (MrDKA, >250 < 600 mg/dL) and hyperosmolar DKA (HyperDKA ≥600 mg/dL).
RESULTS: There were 56 patients (27men, 29women; age 45.8 ± 15.6 (SD) years. The initial 8-h insulin infusion rate (0.05 ± 0.02, 0.09 ± 0.03, 0.14 ± 0.05units/kg/h, p < 0.001) and the time to correction of BG (3.4 ± 1.9, 6.1 ± 2.9 and 9.6 ± 3.9 h, p < 0.001), differed for EuDKA, MrDKA and HyperDKA. There were no differences in the time to correction of AG or [HCO3]. The earlier time to correction of BG in EuDKA resulted in paradoxical longer lag times for correction of [HCO3] (p = 0.003) and AG (p = 0.048). Changes in BG, AG and [HCO3] correlated with insulin infusion rates of 0.08-0.1units/kg/h whereas in EuDKA the insulin infusion rate was 0.05 ± 0.02 units/kg/h.
CONCLUSIONS: In EuDKA, correlation analyses suggest that higher glucose and insulin infusion rates than what would be projected for the level of blood glucose are required to reverse ketoacidosis. Prospective trials are required to optimize the levels of glucose and insulin infusions in EuDKA.
METHODS: Data were retrieved from an electronic health record (EPIC) for \"diabetic ketoacidosis.\" Patients were categorized by initial BG as EuDKA, middle range DKA (MrDKA, >250 < 600 mg/dL) and hyperosmolar DKA (HyperDKA ≥600 mg/dL).
RESULTS: There were 56 patients (27men, 29women; age 45.8 ± 15.6 (SD) years. The initial 8-h insulin infusion rate (0.05 ± 0.02, 0.09 ± 0.03, 0.14 ± 0.05units/kg/h, p < 0.001) and the time to correction of BG (3.4 ± 1.9, 6.1 ± 2.9 and 9.6 ± 3.9 h, p < 0.001), differed for EuDKA, MrDKA and HyperDKA. There were no differences in the time to correction of AG or [HCO3]. The earlier time to correction of BG in EuDKA resulted in paradoxical longer lag times for correction of [HCO3] (p = 0.003) and AG (p = 0.048). Changes in BG, AG and [HCO3] correlated with insulin infusion rates of 0.08-0.1units/kg/h whereas in EuDKA the insulin infusion rate was 0.05 ± 0.02 units/kg/h.
CONCLUSIONS: In EuDKA, correlation analyses suggest that higher glucose and insulin infusion rates than what would be projected for the level of blood glucose are required to reverse ketoacidosis. Prospective trials are required to optimize the levels of glucose and insulin infusions in EuDKA.
摘要：
目的：标准治疗糖尿病酮症酸中毒（DKA）在“正常血糖DKA”中的有效性（EuDKA，血糖（BG）≤250mg/dL）相对于BG≤200mg/dL的校正时间进行评估，阴离子间隙(AG)≤12mmol/L,血清碳酸氢盐[HCO3]≥18mmol/L
方法：从电子健康记录（EPIC）检索糖尿病酮症酸中毒的数据。“患者按初始BG分类为EuDKA，中程DKA(MrDKA,>250<600mg/dL）和高渗性DKA（HyperDKA≥600mg/dL）。
结果：有56名患者（27名男性，29名妇女；年龄45.8±15.6（SD）岁。最初的8小时胰岛素输注速率（0.05±0.02，0.09±0.03，0.14±0.05单位/kg/h，p<0.001）和校正BG的时间（3.4±1.9、6.1±2.9和9.6±3.9h，p<0.001)，对于EuDKA来说是不同的，MrDKA和HyperDKA。校正AG或[HCO3]的时间没有差异。在EuDKA中校正BG的较早时间导致校正[HCO3]（p=0.003）和AG（p=0.048）的矛盾的较长滞后时间。BG的变化，AG和[HCO3]与0.08-0.1单位/kg/h的胰岛素输注速率相关，而在EuDKA中，胰岛素输注速率为0.05±0.02单位/kg/h。
结论：在EuDKA中，相关分析表明,逆转酮症酸中毒需要比预期的血糖水平更高的葡萄糖和胰岛素输注速率.需要进行前瞻性试验以优化EuDKA的葡萄糖和胰岛素输注水平。
方法：从电子健康记录（EPIC）检索糖尿病酮症酸中毒的数据。“患者按初始BG分类为EuDKA，中程DKA(MrDKA,>250<600mg/dL）和高渗性DKA（HyperDKA≥600mg/dL）。
结果：有56名患者（27名男性，29名妇女；年龄45.8±15.6（SD）岁。最初的8小时胰岛素输注速率（0.05±0.02，0.09±0.03，0.14±0.05单位/kg/h，p<0.001）和校正BG的时间（3.4±1.9、6.1±2.9和9.6±3.9h，p<0.001)，对于EuDKA来说是不同的，MrDKA和HyperDKA。校正AG或[HCO3]的时间没有差异。在EuDKA中校正BG的较早时间导致校正[HCO3]（p=0.003）和AG（p=0.048）的矛盾的较长滞后时间。BG的变化，AG和[HCO3]与0.08-0.1单位/kg/h的胰岛素输注速率相关，而在EuDKA中，胰岛素输注速率为0.05±0.02单位/kg/h。
结论：在EuDKA中，相关分析表明,逆转酮症酸中毒需要比预期的血糖水平更高的葡萄糖和胰岛素输注速率.需要进行前瞻性试验以优化EuDKA的葡萄糖和胰岛素输注水平。
