Evaluation of Fluid Therapy by Point-of-Care Ultrasound in Hyperglycemic Emergencies

Aim: Diabetic ketoacidosis (DKA) and Hyperosmolar hyperglycemic state (HHS) are among the cases where total body fluid deficit is high. Although it is known that dehydration is one of the main determinants of mortality and morbidity, it is difficult to determine and follow up fluid treatment in patients with multiple comorbidities. Measurement of the respiratory variability of the vena cava inferior diameter and vena cava inferior / aortic diameter measurement can be performed easily and quickly at the bedside and have a high objectivity compared to physical examination. In this study, we evaluated the follow-up of fluid therapy by POCUS with vena cava inferior diameter and vena cava inferior diameter / abdominal aortic diameter ratio in patients presenting with hyperglycemic emergencies (DKA, HHS, severe hyperglycemia).

Methodology: 56 patients diagnosed with severe hyperglycemia, DKA and HHS according to the American Diabetes Association (ADA) diagnostic criteria were included in the study. Vital signs, laboratory tests(venous blood gas analysis, complete urinalysis, osmolarity, fingertip blood glucose level), fluid volume and bedside ultrasonographic measurements [vena cava inferior inspiration and expiration (iVCI and eVCI) diameter,vena cava inferior colapsiability index (VCI index), abdominal aorta diameter and ratio of vena cava inferior to abdominal aorta diameter (VCI/Ao)] were recorded.

Results: Of the 56 patients, 21.4% were diagnosed with DKA 8.9%, HHS and 69.6% with severe hyperglycemia. There was a significant difference in osmolarity and although pH values ​​were not statistically significant, it tended to improve with the amount of fluid given. There was a significant difference in iVCI, VCI index and VCI/Ao.

Conclusion: We believe that planning and monitoring fluid treatment with bedside ultrasonographic VCI diameter and VCI/Ao ratio measurements will reduce the undesirable complications, the intensity of emergency services, long waiting time and follow-up periods and will contribute to patient benefit and emergency departments.