NECESSITY OF INSULIN AND INTRAVENOUS FLUID IN THE TREATMENT OF DIABETIC KETOACIDOSIS TO AVOID THE CRISIS

Introduction: Diabetic ketoacidosis (DKA) is relatively common in acute metabolic decompensation state of diabetes. It is common in diabetic patients who have stopped taking insulin or have had an infection. Treatment consisted of correcting dehydration, hyperglycemia, electrolyte imbalance, acidosis, and antibiotics in patients with some infection or treating other causes, if any. The aim of this study was to determine the need of insulin and intravenous fluid in the treatment of diabetic ketoacidosis and to avoid any crisis

Methods: This cross-sectional study was conducted in the Medicine Unit-II of Services Hospital Lahore for one-year duration from 1^st July 2019 to 30^th  2020. Fifty adult patients with diabetic ketoacidosis who met inclusion and exclusion criteria to determine the total amount of intravenous fluid (saline) needed to treat diabetic ketoacidosis.

Results: DKA was more common in previously diagnosed (60%) diabetic patients, and the incidence was higher in poor rural residents, and there were no significant differences between the sexes. Together with polyuria (24%) and polydipsia (16%), nausea (32%), vomiting (48%), abdominal pain (28%) and the feature of infection were common. The main cause was infection (38%) and missed insulin doses (34%). In most cases, glycemic status was poor. The majority of patients had mild (32%) to moderate (60%) acidosis, and major electrolyte disturbances were less frequent. Leukocytosis (88%) was consistent even without infection. The result (90% survival) was comparable to the developing world. In the treatment of DKA, 40% of patients required 11 liters of fluid in whom increased diuresis occurred. 24% of patients required 91-100 units of insulin and most (32%) patients required 48 hours to correct their acidosis.

Conclusions: The diagnosis and treatment of diabetic ketoacidosis is not difficult if diagnosed early. Proper fluid replacement is important to prevent mortality.

Keywords: diabetes, diabetic ketoacidosis, insulin, intravenous fluid.