Ways to optimize infusion therapy for diabetic ketoacidosis

Introduction. The problem of endothelioprotection is currently highly relevant for critical care medicine. The effect of diabetic ketoacidosis on the state of endothelial glycocalyx has not been sufficiently studied. The effectiveness of infusion therapy in the treatment of diabetic ketoacidosis is determined by the functional state of the endothelium. The objective was to evaluate the effectiveness of meglumine sodium succinate used in the infusion therapy of diabetic ketoacidosis for correction of endothelial glycocalyx dysfunction Materials and methods. The prospective study included 50 patients with diabetic ketoacidosis, divided into 2 groups – the first, where 0.9% sodium chloride was used as an infusion solution, the second, where meglumine sodium succinate (Reamberin) was added to the infusion program at a daily dose of 10 ml /kg. Two control groups were also examined: 20 healthy volunteers and 20 people with diabetes mellitus without a history of critical complications. Their randomization was carried out using the blind envelope method. We studied the levels of syndecan-1 in blood plasma and the albumin-creatinine ratio of urine (hereinafter referred to as ACR) at baseline in all groups, as well as in the study groups (№ 1 and № 2) during intensive care. Results. Syndecan-1 and ACR levels were lowest in the group of healthy volunteers. In the group of people with diabetes mellitus without critical complications, the level of these markers was statistically significant higher than in healthy volunteers. The highest values of syndecan-1 and ACR markers were in the groups of patients with diabetic ketoacidosis, and at the initial time point, they were representative of each other in both groups. During the study, it was revealed that in the group with the inclusion of Reamberin (group No. 2), the levels of syndecan-1 and ACR were lower in dynamics than in the group using 0.9% sodium chloride exclusively (group No. 1). The maximum difference was reached by 48 hours of intensive care and was 19.3% for syndecan-1 and 17.5% for ACR. Conclusion. The use of polyionic crystalloid solution Reamberin as part of infusion therapy has a positive effect on the state of glycocalyx during intensive care, which reduces the severity of capillary leakage syndrome.