Lipatov Kirill, Kurian Kevin K, Shaver Courtney, White Heath D, Ghamande Shekhar, Arroliga Alejandro C, Surani Salim
Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Baylor Scott and White Health, Temple, TX 76508, United States.
Department of Biostatistics, Baylor Scott and White Health, Temple, TX 76508, United States.
World J Diabetes. 2019 Jan 15;10(1):57-62. doi: 10.4239/wjd.v10.i1.57.
Diabetic ketoacidosis (DKA) has an associated mortality of 1% to 5%. Upon admission, patients require insulin infusion and close monitoring of electrolyte and blood sugar levels with subsequent transitioning to subcutaneous insulin and oral nutrition. No recommendations exist regarding the appropriate timing for initiation of oral nutrition.
To assess short-term outcomes of oral nutrition initiated within 24 h of patients being admitted to a medical intensive care unit (MICU) for DKA.
A retrospective observational cohort study was conducted at a single academic medical center. The patient population consisted of adults admitted to the MICU with the diagnosis of DKA. Baseline characteristics and outcomes were compared between patients receiving oral nutrition within (early nutrition group) and after (late nutrition group) the first 24 h of admission. The primary outcome was 28-d mortality. Secondary outcomes included 90-d mortality, MICU and hospital lengths of stay (LOS), and time to resolution of DKA.
There were 128 unique admissions to the MICU for DKA with 67 patients receiving early nutrition and 61 receiving late nutrition. The APACHE (Acute Physiology and Chronic Health Evaluation) IV mortality and LOS scores and DKA severity were similar between the groups. No difference in 28- or 90-d mortality was found. Early nutrition was associated with decreased hospital and MICU LOS but not with prolonged DKA resolution, anion gap closure, or greater rate of DKA complications.
In patients with DKA, early nutrition was associated with a shorter MICU and hospital LOS without increasing the rate of DKA complications.
糖尿病酮症酸中毒（DKA）的相关死亡率为1%至5%。入院时，患者需要静脉输注胰岛素，并密切监测电解质和血糖水平，随后过渡到皮下注射胰岛素和口服营养。目前尚无关于开始口服营养的合适时机的建议。
评估因DKA入住医学重症监护病房（MICU）的患者在入院24小时内开始口服营养的短期结局。
在一家学术医疗中心进行了一项回顾性观察队列研究。患者群体包括因DKA诊断入住MICU的成年人。比较入院后24小时内接受口服营养的患者（早期营养组）和之后接受口服营养的患者（晚期营养组）的基线特征和结局。主要结局是28天死亡率。次要结局包括90天死亡率、MICU和医院住院时间（LOS）以及DKA缓解时间。
共有128例因DKA入住MICU的患者，其中67例接受早期营养，61例接受晚期营养。两组之间的急性生理与慢性健康状况评估（APACHE）IV死亡率、LOS评分和DKA严重程度相似。未发现28天或90天死亡率有差异。早期营养与缩短医院和MICU住院时间相关，但与DKA缓解时间延长、阴离子间隙闭合或DKA并发症发生率增加无关。
在DKA患者中，早期营养与缩短MICU和医院住院时间相关，且不增加DKA并发症发生率。
