赖脯胰岛素在犬糖尿病酮症酸中毒治疗中的应用。
Use of lispro insulin for treatment of diabetic ketoacidosis in dogs.
作者信息
Sears Kirk W, Drobatz Kenneth J, Hess Rebecka S
机构信息
Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
出版信息
J Vet Emerg Crit Care (San Antonio). 2012 Apr;22(2):211-8. doi: 10.1111/j.1476-4431.2012.00719.x. Epub 2012 Mar 5.
OBJECTIVES
To characterize the use of lispro insulin in dogs with diabetes ketoacidosis (DKA) and to compare the length of time required for resolution of hyperglycemia, ketosis, and acidosis, respectively, in dogs with DKA treated with lispro or with regular insulin.
DESIGN
Randomized prospective clinical trial performed between November 2006 and May 2009.
SETTING
University teaching hospital.
ANIMALS
Client-owned dogs with naturally occurring DKA. Dogs with a blood glucose (BG) > 13.9 mmol/L (>250 mg/dL), blood pH between 7.0 and 7.35, and a blood beta-hydroxybutyrate (BOHB) concentration >2.0 mmol/L were eligible to be enrolled into the study and were randomly assigned to receive an IV continuous rate infusion (CRI) of either lispro or regular insulin.
INTERVENTIONS
Lispro or regular insulin was administered as an IV CRI at an initial dose of 0.09 U/kg/h. The dose was adjusted according to a previously published protocol.
MEASUREMENTS AND MAIN RESULTS
Twelve dogs were enrolled into the study. The time to biochemical resolution of DKA was defined as the time interval from when the IV CRI of insulin began until marked hyperglycemia (BG > 13.9 mmol/L [>250 mg/dL]), acidosis (venous pH < 7.35), and ketosis (BOHB concentration >2.0 mmol/L) resolved. The median time to biochemical resolution of DKA in dogs treated with lispro insulin was significantly shorter (26 h; range 26-50 h) than in dogs treated with regular insulin (61 h; range, 38-80 h, P = 0.02). Median admission blood glucose concentration of all 12 dogs (24 mmol/L [432 mg/dL; range, 17.8-38.9 mmol/L [321-700 mg/dL]) decreased significantly with fluid resuscitation and prior to insulin therapy (20.5 mmol/L [369 mg/dL; range, 14.5-33.3 mmol/L [261-600 mg/dL], P = 0.0085). No adverse effects were observed in association with IV lispro insulin administration.
CONCLUSIONS
Treatment of DKA in dogs with IV CRI lispro insulin is safe, and as effective as treatment with regular insulin.
目的
描述赖脯胰岛素在糖尿病酮症酸中毒（DKA）犬中的应用情况，并比较使用赖脯胰岛素或常规胰岛素治疗的DKA犬分别解决高血糖、酮症和酸中毒所需的时间。
设计
2006年11月至2009年5月进行的随机前瞻性临床试验。
地点
大学教学医院。
动物
患有自然发生的DKA的客户拥有的犬。血糖（BG）>13.9 mmol/L（>250 mg/dL）、血液pH值在7.0至7.35之间且血液β-羟基丁酸（BOHB）浓度>2.0 mmol/L的犬有资格纳入研究，并被随机分配接受赖脯胰岛素或常规胰岛素的静脉持续输注（CRI）。
干预措施
赖脯胰岛素或常规胰岛素以0.09 U/kg/h的初始剂量作为静脉CRI给药。剂量根据先前发表的方案进行调整。
测量和主要结果
12只犬纳入研究。DKA生化指标恢复正常的时间定义为从开始静脉输注胰岛素直至明显的高血糖（BG>13.9 mmol/L [>250 mg/dL]）、酸中毒（静脉pH<7.35）和酮症（BOHB浓度>2.0 mmol/L）得到解决的时间间隔。使用赖脯胰岛素治疗的犬DKA生化指标恢复正常的中位时间（26小时；范围26 - 50小时）显著短于使用常规胰岛素治疗的犬（61小时；范围38 - 80小时，P = 0.02）。所有12只犬的入院中位血糖浓度（24 mmol/L [432 mg/dL；范围17.8 - 38.9 mmol/L [321 - 700 mg/dL]）在液体复苏后及胰岛素治疗前显著降低（20.5 mmol/L [369 mg/dL；范围14.5 - 33.3 mmol/L [261 - 600 mg/dL]，P = 0.0085）。未观察到与静脉注射赖脯胰岛素相关的不良反应。
结论
用静脉CRI赖脯胰岛素治疗犬DKA是安全的，且与常规胰岛素治疗效果相同。
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