Abstract

Evaluation of Fluid Therapy by Point-of-Care Ultrasound in Hyperglycemic Emergencies

Author(s): Busra Bildik

Aims:
Diabetic ketoacidosis (DKA) and Hyperosmolar hyperglycemic state (HHS) are among the cases where
total body fluid deficit is high. Although it is known that dehydration is one of the main determinants of
mortality and morbidity, it is difficult to determine and follow up fluid treatment in patients with multiple
comorbidities. Measurement of the respiratory variability of the vena cava inferior diameter and vena
cava inferior / aortic diameter measurement can be performed easily and quickly at the bedside and have
a high objectivity compared to physical examination. In this study, we evaluated the follow-up of fluid
therapy by POCUS with vena cava inferior diameter and vena cava inferior diameter / abdominal aortic
diameter ratio in patients presenting with hyperglycemic emergencies (DKA, HHS, severe hyperglycemia).
Methodology:
56 patients diagnosed with severe hyperglycemia, DKA and HHS according to the American
Diabetes Association (ADA) diagnostic criteria were included in the study.Vital signs, laboratory
tests(venous blood gas analysis, complete urinalysis, osmolarity, fingertip blood glucose level),
fluid volume and bedside ultrasonographic measurements [vena cava inferior inspiration and
expiration (iVCI and eVCI) diameter,vena cava inferior colapsiability index (VCI index), abdominal
aorta diameter and ratio of vena cava inferior to abdominal aorta diameter (VCI/Ao) ] were recorded.
Results:
Of the 56 patients, 21.4% were diagnosed with DKA 8.9%, HHS and 69.6% with severe hyperglycemia. There
was a significant difference in osmolarity and although pH values were not statistically significant, it tended
to improve with the amount of fluid given. There was a significant difference in iVCI, VCI index and VCI/Ao.
Conclusion:
We believe that planning and monitoring fluid treatment with bedside ultrasonographic VCI diameter and
VCI / Ao ratio measurements will reduce the undesirable complications, the intensity of emergency services,
long waiting time and follow-up periods and will contribute to patient benefit and emergency departments.