Changes of Sublingual Microcirculation during the Treatment of Severe Diabetic Ketoacidosis.

Introduction: Diabetic ketoacidosis (DKA) is associated with volume depletion and hemodynamic alterations. Changes in systemic microcirculation during DKA have not been described so far. Methods: In this case report, we describe the evolution of sublingual microcirculatory changes, monitored using sidestream dark field (SDF) imaging during the treatment of severe diabetic ketoacidosis in a 13-year-old girl. The patient presented a pH of 6.84, a glycemia level of 27.2 mmol/L, a ketonemia level of 5.6 mmol/L, a base excess of -29.4 mmol/L, hypernatremia, hyperosmolality due to acute gastritis, and a malfunction of the glucose sensor. Sublingual microcirculation measurements using an SDF probe were initiated 60 min after the initiation of treatment, which was then repeated 2, 3, 4, 6, 12, and 24 h after treatment initiation, as well as on the day of discharge. Results: Substantial alterations of microvascular perfusion parameters, both total and small vessel densities, perfused vessel densities, and the DeBacker score, were observed during the first 6 to 12 h of treatment. The degree of microcirculatory alteration was strongly negatively correlated with calculated osmolality, sodium levels, ketone and lactate levels, and blood pressure values. Conclusions: DKA is, in its complexity, associated with a serious microcirculatory alteration. SDF imaging provides insight into the severity of the patient's microcirculatory alteration and its evolution during treatment.

Sublingual microcirculation in healthy pediatric population using the sidestream dark-field imaging method.

BACKGROUND: The sidestream dark-field imaging method is used to study microcirculation. Normal values of sublingual microcirculation parameters in healthy children of different age and gender categories are unknown. OBJECTIVE: The study's main goal was to determine normal values of selected parameters of sublingual microcirculation in healthy children of different age and gender categories. METHODS: 40 healthy children were measured, ten aged 3-5.9 years, ten aged 6-10.9 years, ten aged 11-14.9 years, and ten aged 15-18.9 years. After recording the basic anthropometric parameters and vital functions, each volunteer had their microcirculation measured using an SDF probe placed sublingually. Three video clips were recorded and processed offline, and the three best and most stable parts of each were analyzed. RESULTS: Total vascular density, small vessel density, proportion of perfused small vessels, perfused vessel density, perfused small vessel density, and DeBacker's score were significantly higher in females than in males. There were no differences between age groups in microcirculation parameters except MFI. CONCLUSIONS: Age does not influence normal values of microcirculatory parameters. Female gender was associated with higher vessel density, perfused vessel density, and DeBacker's score. A suggestion of the normal range of microcirculatory parameters in healthy children is provided.