TREATMENT OF DIABETIC KETOACIDOSIS UNDER CONTROL OF BLOOD GASES AND ACID-BASE BALANCE

Abstract

Determination of gas composition in arterial blood is an obligatory method of a laboratory research of patients, according to protocols of treatment of diabetic ketoacidosis. On their dynamic changes it is possible to estimate efficiency of treatment quicker. Use of antihypoxants in complex treatment of metabolic encephalopathies is estimated by experts at various critical pathological conditions.

The aim of the study – to learn studying of gas exchange violations at diabetic ketoacidosis and their dynamics in the course of treatment, with and without application of antihypoxants.

Materials and Methods. Among 55 patients with diabetic ketoacidosis aged from 9 to 65 years (the average age of the patients was (31.58±17.18) years), 38 people were selected, who simultaneously determined the gas composition of venous and arterial blood with Easy Blood Gas (USA, 2008) upon admission and through the day of the pathogenetic treatment. One group of 19 people (Group A) received basic pathogenetic therapy, the other (Group B with clinically pronounced suppression of the nervous system) – additionally intravenous drip of deproteinized hemoderivate from the blood of calves or succinic acid solution in combination with vitamins.

Results and Discussion. Indicators of venous blood at admission: oxygen tension 29.00 mm Hg in group A, 45 mm Hg in Group B, the carbon dioxide voltage is 30.80 mm Hg in Group A, 26.10 mm Hg in – in Group B, the total carbon dioxide content is 13.00 mmol / l in Group A, 8.20 mmol / l in Group B. These indicators were statistically significantly different (p <0.05). Indicators of acid-base balance, in turn, with effectively statistically insignificant difference in blood pH between the groups differed statistically significantly in the level of blood bicarbonate and standard bicarbonate. The median of these parameters, respectively, was 4.10 mmol / l; 12.85 mmol / l in Group A, 7.30 mmol / l; 7.30 mmol / l in Group B. Also differed were groups of patients with statistically significant difference (p <0.05) by respiratory coefficient (Me = 2.73: 1.50; 5.07 in Group A, Me = 1.65: 1.02; 2.34 in Group B). But arterial blood counts at admission differed in groups only by respiratory coefficient (Me = 0.06: 0.03; 0.11 in Group A, Me = 0.31: 0.08; 1.27 in Group B). A day after the treatment, the composition of arterial blood was not statistically significantly different in the Groups. But in the venous blood was statistically significantly different (p <0.05) in terms of the following parameters: oxygen tension in mm Hg (Me = 30.00: 21.00; 47.00 in Group A, Me = 43.00: 36.00; 55.00 in Group B), the voltage of carbon dioxide in mm Hg (Me = 37.20: 31.80; 47.30 in Group A,
Me = 30.30: 25.40; 36.80 in Group B), the total oxygen content in mg / dL (Me = 11.20: 5.80; 16.30 in Group A, Me = 16.60: 14.10; 18.10 in Group B).

Conclusions. The inclusion of antihypoxants to the complex treatment of diabetic ketoacidosis influenced to a large extent the indicators of gas exchange disorders of venous blood. Considering the above results of the study of blood gases, the effect of antihypoxants was based on the effect on dissolved forms of oxygen and carbon dioxide, without affecting the gaseous fractions of these gases, the level of which depends more on ventilation and blood circulation. Obviously, there was an improvement in the absorption of oxygen by the tissues against the background of the therapy of the critical state and the rapid compensation of acid-base balance, a more rapid elimination of acidosis compared with the compensation of tissue hypoxia against the background of blood hyperoxia.