The Changes of Serum Sodium, Potassium, Glucose and Blood Gases During The First Eight Hours of Treatment in Diabetic ketoacidosis

Cerebral edema has long been recognized as a complication of treatment of diabetic ketoacidosis, particularly in children, with a poor outcome. The most reported feature is the use of hypotonic fluids with failure in rising sodium and a rapid decrease in serum osmolality. This prospective study was designed to determine the changes in sodium, potassium, glucose, PH and bicarbonate during the first eight hours of treatment in patients with diabetic ketoacidosis. Eighty-three patients under 20 years with documented diagnosis of diabetic ketoacidosis (DKA) were invited in order to determine the changes of serum sodium, potassium and glucose as well as the changes of blood gases during the first 8 hrs of treatment with normal saline and insulin infusion. Overall 63.9% of the patients were female and 36.1% were male. The mean patients’ age on presentation was 11.67±5.37 years and at the time of diabetes onset was 10.38±5.16 years. Past history of DKA attack was seen in 12% of cases and DKA was the first manifestation of diabetes in 37.3% of cases. During the first 8 hours of treatment, the means of potassium and glucose reduction were 0/83 meq/L and 316/23 mg/dL respectively. The means of sodium and bicarbonate increase were 7/79 and 4/75 meq/L respectively and the mean of PH increase was %16. Results of this study show that cerebral edema is rarely if ever seen if isotonic saline is used as the primary rehydration solution and during treatment sodium increment is helpful to prevent rapid fall in extra cellular fluid osmolality, so it seems isotonic saline is the appropriate initial replacement fluid.