ABSTRACT
OBJECTIVE: To determine if Ringer's lactate is superior to 0.9% sodium chloride solution for resolution of acidosis in the management of diabetic ketoacidosis (DKA). DESIGN: Parallel double blind randomized controlled trial. METHODS: Patients presenting with DKA at Kalafong and Steve Biko Academic hospitals were recruited for inclusion in this study if they were >18 years of age, had a venous pH >6.9 and ≤7.2, a blood glucose of >13 mmol/l and had urine ketones of ≥2+. All patients had to be alert enough to give informed consent and should have received <1 l of resuscitation fluid prior to enrolment. RESULTS: Fifty-seven patients were randomly allocated, 29 were allocated to receive 0.9% sodium chloride solution and 28 to receive Ringer's lactate (of which 27 were included in the analysis in each group). An adjusted Cox proportional hazards analysis was done to compare the time to normalization of pH between the 0.9% sodium chloride solution and Ringer's lactate groups. The hazard ratio (Ringer's compared with 0.9% sodium chloride solution) for time to venous pH normalization (pH = 7.32) was 1.863 (95% CI 0.937-3.705, P = 0.076). The median time to reach a pH of 7.32 for the 0.9% sodium chloride solution group was 683 min (95% CI 378-988) (IQR: 435-1095 min) and for Ringer's lactate solution 540 min (95% CI 184-896, P = 0.251). The unadjusted time to lower blood glucose to 14 mmol/l was significantly longer in the Ringer's lactate solution group (410 min, IQR: 240-540) than the 0.9% sodium chloride solution group (300 min, IQR: 235-420, P = 0.044). No difference could be demonstrated between the Ringer's lactate and 0.9% sodium chloride solution groups in the time to resolution of DKA (based on the ADA criteria) (unadjusted: P = 0.934, adjusted: P = 0.758) CONCLUSION: This study failed to indicate benefit from using Ringer's lactate solution compared to 0.9% sodium chloride solution regarding time to normalization of pH in patients with DKA. The time to reach a blood glucose level of 14 mmol/l took significantly longer with the Ringer's lactate solution.
Subject(s)
Diabetic Ketoacidosis/therapy , Fluid Therapy/methods , Isotonic Solutions/therapeutic use , Adult , Blood Glucose/metabolism , Diabetes Mellitus, Type 1/blood , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 2/blood , Diabetes Mellitus, Type 2/complications , Diabetic Ketoacidosis/blood , Diabetic Ketoacidosis/etiology , Double-Blind Method , Female , Humans , Hydrogen-Ion Concentration , Male , Middle Aged , Ringer's Lactate , Sodium Chloride/therapeutic use , Treatment Outcome , Young AdultABSTRACT
BACKGROUND: During inflammation, the serum concentrations of granulocyte colony stimulating factor (G-CSF), plasma interleukin-6 (IL-6), and C-reactive protein (CRP) increase. A positive correlation between CRP and the percentages of neutrophils exhibiting toxic granulation during inflammation has been demonstrated, and that the fluctuations of CRP and toxic granulation of neutrophils were similar. OBJECTIVES: We studied whether grading of toxic granulated neutrophils can be used as a surrogate marker for infection or inflammation, and also be an easier method than previously described methods. MATERIALS AND METHODS: We graded 357 consecutive peripheral blood slides from patients on whom a full blood count with differential count and CRP level was performed, according to intensity of toxic granulation in the neutrophil population, according to a newly proposed grading system. RESULTS: The CRP range was between 1 and 530.3 mg/l. The results confirm the association between a rise in CRP and progressive intensity of toxic granulation in neutrophils in peripheral blood. Kruskal-Wallis equality of populations rank test showed a statistically significant difference between the graded categories (p=0.0001). The Trend test was also statistically significant (p=0.000). CONCLUSION: The proposed system can be applied to patients with inflammatory or infectious conditions, where grading of toxic granulation of neutrophils can possibly be used as a surrogate marker to assess infection or inflammation and their response to treatment. It may be of particular use in cases where traditional infectious or inflammatory markers cannot be used, owing to inherent problems associated with the respective conditions.
Subject(s)
C-Reactive Protein/analysis , Neutrophils/pathology , Biomarkers/blood , Humans , Infections/blood , Inflammation/blood , Leukocyte CountABSTRACT
El impacto de las enfermedades de origen hidrico en Sudafrica es significativo, ya que la diarrea es la principal causa del 20
de las muertes entre 1 y 5 años y la calidad del agua en las comunidades rurales es pobre. Se brinda un panorama de la situacion en Sudafrica, se propone la puesta en marcha de procedimientos de evaluacion y monitoreo para revertir la situacion hacia niveles de calida de agua mas aceptables, y se describe el exito obtenido en seis comunidades rurales
Subject(s)
Water Supply, Rural , Water Supply , Rural Areas , Water Quality , Drinking Water , Organization and AdministrationABSTRACT
El impacto de las enfermedades de origen hidrico en Sudafrica es significativo, ya que la diarrea es la principal causa del 20 de las muertes entre 1 y 5 años y la calidad del agua en las comunidades rurales es pobre. Se brinda un panorama de la situacion en Sudafrica, se propone la puesta en marcha de procedimientos de evaluacion y monitoreo para revertir la situacion hacia niveles de calida de agua mas aceptables, y se describe el exito obtenido en seis comunidades rurales
