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QJM 2005 98(4):318; doi:10.1093/qjmed/hci049
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The Author 2005. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org

Correspondence

Recent advances in the monitoring and management of diabetic ketoacidosis

Sir,

In their helpful review on diabetic ketoacidosis (DKA), we are pleased that Wallace and Matthews1 encourage determination of capillary blood ketone concentrations using portable meters. They state that no randomized controlled trial has investigated the use of routine ketone monitoring in DKA. Bedside monitoring of 3-hydroxybutyrate concentrations in DKA has been used in our unit for some time.2 Monitoring alone, however, unless accompanied by a change in management, is unlikely to alter outcome.

We performed a randomized controlled trial of an extended insulin regimen in DKA.3 After correction of hyperglycaemia, intravenous insulin (5 U/h) was continued along with dextrose, until 3-hydroxybutyrate concentration determined by a portable meter was normalized. Compared to a conventional regimen, in which insulin doses were reduced after achievement of normoglycaemia, the extended regimen resulted in more effective correction of ketosis and a trend towards more rapid resolution of acidosis. This extended insulin regimen supported by monitoring of capillary blood 3-hydroxybutyrate concentrations with a portable meter continues to be used routinely in our unit.

P.M. Bell, M.I. Wiggam and D.R. Hadden

Regional Centre for Endocrinology and Diabetes Royal Victoria Hospital Belfast

References

1. Wallace TM, Mathews DR. Recent advances in the monitoring and management of diabetic ketoacidosis. Q J Med 2004; 97:773–80.

2. McBride MO, Smye M, Nesbitt GS, Hadden DR. Bedside blood ketone body monitoring. Diabet Med 1991; 8:688–90.[Web of Science][Medline]

3. Wiggam MI, O’Kane MJ, Harper R, Atkinson AB, Hadden DR, Trimble ER, Bell PM. Treatment of diabetic ketoacidosis using normalisation of blood 3-hydroxybutyrate concentration as an endpoint of emergency management. Diabetes Care 1997; 20:1347–52.[Abstract]


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This Article
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