Early vs late oral nutrition in patients with diabetic ketoacidosis admitted to a medical intensive care unit
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摘要
BACKGROUND Diabetic ketoacidosis(DKA) has an associated mortality of 1% to 5%. Upon admission, patients require insulin infusion and close monitoring of electrolyte and blood sugar levels with subsequent transitioning to subcutaneous insulin and oral nutrition. No recommendations exist regarding the appropriate timing for initiation of oral nutrition.AIM To assess short-term outcomes of oral nutrition initiated within 24 h of patients being admitted to a medical intensive care unit(MICU) for DKA.METHODS A retrospective observational cohort study was conducted at a single academic medical center. The patient population consisted of adults admitted to the MICU with the diagnosis of DKA. Baseline characteristics and outcomes were compared between patients receiving oral nutrition within(early nutrition group) and after(late nutrition group) the first 24 h of admission. The primary outcome was 28-d mortality. Secondary outcomes included 90-d mortality, MICU and hospital lengths of stay(LOS), and time to resolution of DKA.RESULTS There were 128 unique admissions to the MICU for DKA with 67 patientsreceiving early nutrition and 61 receiving late nutrition. The APACHE(Acute Physiology and Chronic Health Evaluation) IV mortality and LOS scores and DKA severity were similar between the groups. No difference in 28-or 90-d mortality was found. Early nutrition was associated with decreased hospital and MICU LOS but not with prolonged DKA resolution, anion gap closure, or greater rate of DKA complications.CONCLUSION In patients with DKA, early nutrition was associated with a shorter MICU and hospital LOS without increasing the rate of DKA complications.
BACKGROUND Diabetic ketoacidosis(DKA) has an associated mortality of 1% to 5%. Upon admission, patients require insulin infusion and close monitoring of electrolyte and blood sugar levels with subsequent transitioning to subcutaneous insulin and oral nutrition. No recommendations exist regarding the appropriate timing for initiation of oral nutrition.AIM To assess short-term outcomes of oral nutrition initiated within 24 h of patients being admitted to a medical intensive care unit(MICU) for DKA.METHODS A retrospective observational cohort study was conducted at a single academic medical center. The patient population consisted of adults admitted to the MICU with the diagnosis of DKA. Baseline characteristics and outcomes were compared between patients receiving oral nutrition within(early nutrition group) and after(late nutrition group) the first 24 h of admission. The primary outcome was 28-d mortality. Secondary outcomes included 90-d mortality, MICU and hospital lengths of stay(LOS), and time to resolution of DKA.RESULTS There were 128 unique admissions to the MICU for DKA with 67 patientsreceiving early nutrition and 61 receiving late nutrition. The APACHE(Acute Physiology and Chronic Health Evaluation) IV mortality and LOS scores and DKA severity were similar between the groups. No difference in 28-or 90-d mortality was found. Early nutrition was associated with decreased hospital and MICU LOS but not with prolonged DKA resolution, anion gap closure, or greater rate of DKA complications.CONCLUSION In patients with DKA, early nutrition was associated with a shorter MICU and hospital LOS without increasing the rate of DKA complications.
BACKGROUND Diabetic ketoacidosis(DKA) has an associated mortality of 1% to 5%. Upon admission, patients require insulin infusion and close monitoring of electrolyte and blood sugar levels with subsequent transitioning to subcutaneous insulin and oral nutrition. No recommendations exist regarding the appropriate timing for initiation of oral nutrition.AIM To assess short-term outcomes of oral nutrition initiated within 24 h of patients being admitted to a medical intensive care unit(MICU) for DKA.METHODS A retrospective observational cohort study was conducted at a single academic medical center. The patient population consisted of adults admitted to the MICU with the diagnosis of DKA. Baseline characteristics and outcomes were compared between patients receiving oral nutrition within(early nutrition group) and after(late nutrition group) the first 24 h of admission. The primary outcome was 28-d mortality. Secondary outcomes included 90-d mortality, MICU and hospital lengths of stay(LOS), and time to resolution of DKA.RESULTS There were 128 unique admissions to the MICU for DKA with 67 patientsreceiving early nutrition and 61 receiving late nutrition. The APACHE(Acute Physiology and Chronic Health Evaluation) IV mortality and LOS scores and DKA severity were similar between the groups. No difference in 28-or 90-d mortality was found. Early nutrition was associated with decreased hospital and MICU LOS but not with prolonged DKA resolution, anion gap closure, or greater rate of DKA complications.CONCLUSION In patients with DKA, early nutrition was associated with a shorter MICU and hospital LOS without increasing the rate of DKA complications.
引文
1 Kitabchi AE,Umpierrez GE,Miles JM,Fisher JN.Hyperglycemic crises in adult patients with diabetes.Diabetes Care 2009;32:1335-1343[PMID:19564476 DOI:10.2337/dc09-9032]
2 Venkatesh B,Pilcher D,Prins J,Bellomo R,Morgan TJ,Bailey M.Incidence and outcome of adults with diabetic ketoacidosis admitted to ICUs in Australia and New Zealand.Crit Care 2015;19:451[PMID:26715333 DOI:10.1186/s13054-015-1171-7]
3 Barski L,Nevzorov R,Rabaev E,Jotkowitz A,Harman-Boehm I,Zektser M,Zeller L,Shleyfer E,Almog Y.Diabetic ketoacidosis:clinical characteristics,precipitating factors and outcomes of care.Isr Med Assoc J 2012;14:299-303[PMID:22799061]
4 Malone ML,Gennis V,Goodwin JS.Characteristics of diabetic ketoacidosis in older versus younger adults.J Am Geriatr Soc 1992;40:1100-1104[PMID:1401693 DOI:10.1111/j.1532-5415.1992.tb01797.x]
5 Desai SV,McClave SA,Rice TW.Nutrition in the ICU:an evidence-based approach.Chest 2014;145:1148-1157[PMID:24798840 DOI:10.1378/chest.13-1158]
6 Rugeles S,Villarraga-Angulo LG,Ariza-Gutiérrez A,Chaverra-Kornerup S,Lasalvia P,Rosselli D.High-protein hypocaloric vs normocaloric enteral nutrition in critically ill patients:Arandomized clinical trial.J Crit Care 2016;35:110-114[PMID:27481744 DOI:10.1016/j.jcrc.2016.05.004]
7 Paoli A.Ketogenic diet for obesity:friend or foe?Int J Environ Res Public Health 2014;11:2092-2107[PMID:24557522 DOI:10.3390/ijerph110202092]
8 Andrade-Castellanos CA,Colunga-Lozano LE,Delgado-Figueroa N,Gonzalez-Padilla DA.Subcutaneous rapid-acting insulin analogues for diabetic ketoacidosis.Cochrane Database Syst Rev2016;CD011281[PMID:26798030 DOI:10.1002/14651858.CD011281.pub2]
2 Venkatesh B,Pilcher D,Prins J,Bellomo R,Morgan TJ,Bailey M.Incidence and outcome of adults with diabetic ketoacidosis admitted to ICUs in Australia and New Zealand.Crit Care 2015;19:451[PMID:26715333 DOI:10.1186/s13054-015-1171-7]
3 Barski L,Nevzorov R,Rabaev E,Jotkowitz A,Harman-Boehm I,Zektser M,Zeller L,Shleyfer E,Almog Y.Diabetic ketoacidosis:clinical characteristics,precipitating factors and outcomes of care.Isr Med Assoc J 2012;14:299-303[PMID:22799061]
4 Malone ML,Gennis V,Goodwin JS.Characteristics of diabetic ketoacidosis in older versus younger adults.J Am Geriatr Soc 1992;40:1100-1104[PMID:1401693 DOI:10.1111/j.1532-5415.1992.tb01797.x]
5 Desai SV,McClave SA,Rice TW.Nutrition in the ICU:an evidence-based approach.Chest 2014;145:1148-1157[PMID:24798840 DOI:10.1378/chest.13-1158]
6 Rugeles S,Villarraga-Angulo LG,Ariza-Gutiérrez A,Chaverra-Kornerup S,Lasalvia P,Rosselli D.High-protein hypocaloric vs normocaloric enteral nutrition in critically ill patients:Arandomized clinical trial.J Crit Care 2016;35:110-114[PMID:27481744 DOI:10.1016/j.jcrc.2016.05.004]
7 Paoli A.Ketogenic diet for obesity:friend or foe?Int J Environ Res Public Health 2014;11:2092-2107[PMID:24557522 DOI:10.3390/ijerph110202092]
8 Andrade-Castellanos CA,Colunga-Lozano LE,Delgado-Figueroa N,Gonzalez-Padilla DA.Subcutaneous rapid-acting insulin analogues for diabetic ketoacidosis.Cochrane Database Syst Rev2016;CD011281[PMID:26798030 DOI:10.1002/14651858.CD011281.pub2]