Unique options for the correction of carbohydrate metabolism disorders
Authors: Halushko O.A. 
Published: July 2021

Background. Deep and versatile disorders in case of acute diseases can lead to severe metabolic disorders that are life-threatening and require immediate care. Such conditions include carbohydrate metabolism disorders (CMD): ketoacidosis, non-diabetic ketoacidosis, ketoacidotic and hyperosmolar coma, hypoglycemic syndrome, hypoglycemic and lactic acid coma.

Objective. To describe the possibilities of CMD correction.

Materials and methods. Analysis of literature sources on this topic; own study involving 126 patients with CMD. Patients were prescribed classic and balanced crystalloids (1200-1400 ml per day), in case of ketoacidosis – Xylate (6-8 ml/kg/day), in case of hyperosmolar conditions – Volutenz (400-600 ml per day).

Results and discussion. Necessary laboratory tests in CMD include the assessment of glycemia, potassium, sodium, urea, creatinine, acid-base status, ketonemia, ketonuria; clinical blood test; blood culture and antibiotic sensitivity determination (according to the indications). It should be noted that the level of glycemia in diabetic ketoacidosis (DKA) can vary from a slight increase to a severe hyperglycemia. In case of the clinical picture of advanced ketoacidosis the semiquantitative analysis can reveal 3-4 pluses of ketonuria. However, the nitroprusside method allows to determine acetoacetic acid only, whereas the severe DKA is characterized by the more pronounced increase in the content of β-oxybutyric acid. It may create the preconditions for the underdiagnosis of ketoacidosis. Due to certain features of the analysis, ketosis is usually diagnosed in a decompensated state. Therefore, first of all, it is necessary to be rely by a clinical condition of the patient. Infusion therapy (IT) for DKA involves the use of 0.9 % NaCl solution or Ringer’s solution. If the patient has hypernatremia, 0.45 % NaCl solution is administered. During the first 30-60 minutes of treatment one should administered 1 liter of these solutions. Subsequently, the infusion is continued at a rate of 4-14 ml/kg/h until the glucose level reaches <12 mmol/L, then the infusion should be continued with 5 % glucose solution. IT must be performed with caution in elderly patients and people with heart failure. In addition to IT, insulin therapy (0.1 U/kg/h) is prescribed for DKA, followed by dose adjustment to ensure a decrease in blood glucose concentration at a rate of 2-3 mmol/L. Acidosis is corrected by IT and insulin therapy. Treatment of severe acidosis (pH <7.0) with bicarbonate requires dose adjustment under acid-base control. Xylitol (Xylate, “Yuria-Pharm”) is the main antiketogenic solution. It enters the pentose phosphate metabolism, increases the intensity of glycolysis, enhances glycogen production in the liver and stimulates insulin secretion. On the background of Xylate use, the content of β-oxybutyrate in the urine is halved in 5 hours, and the level of acetone – decreases in 2.5 times in 2 hours. Xylate reduces lactate levels and normalizes tissue perfusion. The unique effects of Xylate include pronounced antiketogenic effect, correction of metabolic acidosis, role as a non-insulin-independent energy source, correction of water-electrolyte balance, and hydration. Evaluation of the effectiveness of therapy in patients with DKA should include regular monitoring of neurological status. If deterioration is observed, cerebral edema, stroke, infectious diseases of the central nervous system, traumatic brain injury, hyperosmolar condition should be excluded. In the latter case, it is advisable to enter a hypotonic solution of 0.45 % NaCl. Because the use of such solutions is associated with a risk of cerebral edema, most recommendations prefer isotonic solutions.

In the own study, the described above IT scheme helped to reduce the total volume of infusions, increase diuresis, improve consciousness on the 3rd day of treatment, and reduce the length of stay in the intensive care unit.

Conclusions. 1. Many patients develop CMD, which worsen the course and prognosis of the underlying disease. 2. The use of IT should be started at the first signs of DKA. 3. Modern antiketogenic agent Xylate affects the pathogenesis of CMD and has an additional energy effect.