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Stewart (physicochemical) approach versus conventional anion gap approach for resolution of metabolic acidosis in diabetic ketoacidosis

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International Journal of Diabetes in Developing Countries Aims and scope Submit manuscript

Abstract

Background

Diabetic ketoacidosis (DKA) frequently requires emergency admission. The anion gap approach is conventionally used for the diagnosis and documenting the resolution of acidosis during treatment. However, it fails to detect hyperchloremic acidosis during the resolution and may result in the prolongation of treatment.

Objectives

To determine the role of the Stewart approach of acid-base disorder during DKA management for the prediction of an earlier resolution.

Methods

A prospective comparative study was conducted between January 2017 and December 2017 at a single academic hospital in north India. Patients aged above 12 years with a diagnosis of DKA were randomly divided into two groups—the conventional group and the Stewart group, according to the approach used for DKA resolution. The primary outcome was the time duration required for resolution. The secondary outcomes were the therapeutic requirement of intravenous fluid, insulin, and potassium, Acute Physiology and Chronic Health Evaluation II (APACHE II) score at the time of resolution, and hospital stay.

Results

Forty-four DKA patients were equally distributed in the two groups with comparable baseline parameters. The Stewart group had early resolution of DKA (mean, 32.4±17.5 h versus 41.7±19.6 h; p value <0.001) at similar APACHE II scores. The duration of hospital stay was reduced but was not statistically significant (mean, 5.6±3.2 days versus 7.0±3.8 days; p value 0.16). The therapeutic requirement of fluid, insulin, and potassium was similar in groups.

Conclusion

The Stewart approach may be a better alternative to the conventional anion gap approach for guiding the resolution of DKA.

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Author information

Authors and Affiliations

  1. Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, 4th floor, F block, Chandigarh, India

    Ashok Kumar Pannu, Rakesh Sharma, Navneet Sharma & Susheel Kumar

  2. Department of Biochemistry, Postgraduate Institute of Medical Education and Research, 1150, Sector 24B, Chandigarh, India

    Jyotdeep Kaur

  3. Department of Endocrinology, Nehru Hospital Extension block, Postgraduate Institute of Medical Education and Research, Room no. 1005, Ground floor, Chandigarh, India

    Rama Walia

Authors
  1. Ashok Kumar Pannu
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  2. Rakesh Sharma
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  3. Navneet Sharma
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  4. Jyotdeep Kaur
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  5. Rama Walia
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  6. Susheel Kumar
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Contributions

AKP: patient management, drafted and revised the manuscript.

RS: patient management, collected patient data, drafted the manuscript.

NS: patient management, drafted, and revised the manuscript.

JK: patient management, revised the manuscript.

RW: patient management, revised the manuscript.

SK: patient management, revised the manuscript.

Corresponding author

Correspondence to Navneet Sharma.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study protocol was approved by the Institutional Ethics Committee (IEC No.:INT/IEC/2020/SPL-546), and written informed consent was obtained from all participants and the parents or relatives of the participants age below 16 years.

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Pannu, A.K., Sharma, R., Sharma, N. et al. Stewart (physicochemical) approach versus conventional anion gap approach for resolution of metabolic acidosis in diabetic ketoacidosis. Int J Diabetes Dev Ctries 41, 628–633 (2021). https://doi.org/10.1007/s13410-021-00927-7

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  • DOI: https://doi.org/10.1007/s13410-021-00927-7

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