Международный эндокринологический журнал 1 (65) 2015

Diabetic ketoacidosis (DKA) – an acute decompensation of diabetes with hyperglycemia, ketonuria, metabolic acidosis (pH<7.3) and varying degrees of impaired consciousness or without and requiring emergency hospitalization.

Purpose: to investigate the effect of multicomponent drug (Xylat) on the level of ketone bodies in the blood of patients with diabetic ketoacidosis.

Materials and Methods: examined 35 patients with diabetic ketoacidosis, including 16 women and 19 men, aged 19 to 82 years. Moreover, most of them were with type 2 diabetes (n = 19) and the lower part – with type 1 diabetes (n = 16). All patients received insulin therapy during stay in hospital. Patients received multicomponent drug Xylat 200 to 800 ml/day depending on the clinical situation, within 10 days. Patients were determined before and after 10 days of infusion therapy levels of ketone bodies in the blood with ELISA (using kits KBD-100, USA). Total cholesterol, triglycerides (TG), low density lipoprotein (LDL), very low density lipoproteins (VLDL), high-density lipoprotein (HDL); glucose and glycated hemoglobin (HbA1c); biochemical parameters: potassium (K), sodium (Na), total bilirubin, alanine transaminase (ALT), aspartate transaminase (AST) were determined by conventional methods.

Results. HbA1c level was initially 12.38±0.45%, indicating a significant and sustained diabetes decompensation. Fasting glucose level on admission in the endocrinology department was averaged 12.38±0.7 mmol/l and decreased to 9.34±0.4 mmol/l (p <0.01) after 10 days of treatment. Observed some changes in lipid spectrum in the patients, due to prolonged decompensation of carbohydrate metabolism and, consequently, lipid metabolism. We observed significant changes of lipid spectrum after only 10 days of treatment. This indicates a positive treatment effect Xylat on lipid metabolism in patients with diabetes. As osmolarity of Xylatis 610 mOsm/l, we decided to investigate the effect of therapy on blood osmolarity patients with moderate ketoacidosis. Osmolarity was calculated by the following formula: 2 × [K (mmol/L) + Na (mmol/L)] + glucose (mmol/l). Thus, the osmolarity of blood was averaged initially 299.09±1.2 mOsm/L and did not change significantly after 10 days of treatment – 298.17±0.8 mOsm/L (p> 0.05). At the same time, the level of total ketone bodies in the blood of patients during hospitalization was 4.80±0,65 mmol/l, more than 10 times above normal, and decrease after treatment to 1.95±0.23 mmol/l (p <0.01). Increased ketone bodies took place largely at the expense of acetoacetic acid 3.07±0.44 mmol/l, and to a lesser extent by beta-hydroxybutyric acid whose concentration was 1.73±0.40 mmol/l. We observed lower levels of ketone bodies as acetoacetic acid and beta-hydroxybutyric acid to 1.52±0.22 mmol/l and 0.43±0.07 mmol/L, respectively (p <0.01) after 10 days of infusion therapy.

Conclusions. Infusion therapy multi-component drug (Xylat) leads to a possible reduction in the total ketone bodies and their fractions in the blood of patients with diabetic ketoacidosis within 10 days and reduces the toxic effects ketone to the functioning of all organs and systems. Treatment by multicomponent hyperosmolar solution (Xylat) for 10 days is not increased osmolarity of the blood of patients with diabetes. Reducing the levels of total cholesterol, triglycerides, LDL and VLDL indicates the favorable effect of the therapy on lipid metabolism.