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Cetoacidosis diabética: Casuística 2008-2012, epidemiología y fisiopatología. / [Treatment of diabetic ketoacidosis using 2009 American Diabetes Association guidelines].

Olmos, Pablo; Donoso, Aníbal; Arab, Juan Pablo; Niklitschek, Ian; Mertens, Nicolás; Arce, Elizabeth; Lemus, Rosario; Serrano, Valentina; Grassi, Bruno; Strodthoff, Kristel; Abbott, Eduardo; Aizman, Andrés; González, María Verónica.
Rev Med Chil; 142(10): 1267-74, 2014 Oct.
Artigo em Espanhol | MEDLINE | 2014 | ID: mdl-25601111
Resumo: BACKGROUND: During 2009, new guidelines for the treatment of diabetic ketoacidosis were published by the American Diabetes Association. AIM: To assess the impact of new treatment guidelines on the evolution of patients treated for diabetic ketoacidosis (KAD). PATIENTS AND METHODS: Anonymous data was obtained from computational medical records of patients treated for KAD at our institution two years before ("Traditional Protocol") and TWO years after ("ADA-2009 Protocol") the publication of the 2009 American Diabetes Association (ADA) KAD guidelines. RESULTS: Twenty three patients aged 36.5 ± 15.1 years were treated with the traditional method and 23 patients aged 44.4 ± 21.1 years were treated following 2009 ADA guidelines. Among patients treated with the traditional protocol and treated following ADA 2009 guidelines, the diabetes type 1/type 2 ratio was 18/5 and 19/16 respectively (p = NS), the glycosylated hemoglobin on admission was 12.6 ± 2.5 and 14.3 ± 2.7% respectively (p = 0.03), minimal blood pH was 7.15 ± 0.14 and 7.19 ± 0.09 respectively (p = NS), bicarbonate was required in seven and no patient respectively (p = 0.01), hypokalemia < 3.5 mEq/L occurred in 78.2 and 48.5% of patients (p = 0.03), the lapse until resolution was 28.7 ± 28.0 and 28.8 ± 20.6 hours (p = NS). Only one patient, treated following ADA 2009 guidelines, died. CONCLUSIONS: Introduction of the ADA-2009 protocol for the treatment of KAD resulted in decrease in the use of intravenous bicarbonate and a reduction in the incidence of hypokalemia. There was no impact neither in the lapse until resolution or lethality.