Bolo inicial en la terapia con infusión de insulina vs infusión continua de insulina en el tratamiento de la cetoacidosis diabética en el hospital general de zona No.8

Abstract

INITIAL BOLUS IN INSULIN INFUSION THERAPY VS. CONTINUOUS INSULIN INFUSION IN THE TREATMENT OF DIABETIC KETOACIDOSIS IN THE EMERGENCY SERVICE OF THE HGZ/UMF #8 “DR. GILBERTO FLORES IZQUIERDO” AUTHORS: Dra. Polaco de la Vega, Thalyna**, Dr. Ruiz Lugo David*, Dr Cruz Castillo Fernando*; 2010. * attending physician at the emergency service HGZ/UMF #8 ** Third year resident physician from the medical emergencies specialty from HGZ/UMF #8 OBJECTIVE: To prove if by skipping the initial bolus of rapid insulin and increasing the dosage of continuous infusion gives a better glucemic control, avoiding the hypokalemia and obtaining an early resolution to patients with diabetic ketoacidosis, in comparison to the standard infusion. METHODS AND MATERIALS: An experimental, prospective, comparative and lengthwise study was performed in 60 patients in the period within January 1st and December 31 of 2010 to decompensated type 2 diabetic patients with diabetic ketoacidosis who were admitted to emergency service from HGZ/UMF #8 “Dr. Gilberto Flores Izquierdo” and had the inclusion criteria for this study. Two groups were made in an random way, the patients of the first group were treated with an initial bolus of quick insulin at a rate of 0.1 U/Kg, followed by a intravenous continuous infusion at a rate of 0.1 U/Kg/Hr, the second group was treated with quick insulin in an continuous infusion of 0.14 U/Kg IV. 13 RESULTS: by the means of this study, and utilizing the statistical test of square chi, it was found that from 100% of the patients, 50% were male and 50% female; regarding the glucose at 12 hours, 2 patients from group 2 and 10 patients from group 1 showed hypoglycemia and only one patient with moderate hypokalemia and 1 with severe hypokalemia in the group 2, meanwhile the first group only had 20 patients with moderate hypokalemia and 4 with severe hypokalemia. CONCLUTIONS: It was concluded through this study that the use of infusion at 0.14 U/Kg/Hr causes less hypoglycemia and hypokalemia in comparison to the bolus administration and infusion of 0.1 U/Kg/Hr, and the presentation of the resolution criteria in an earlier fashion, accomplishing the objectives of this work, and accepting the hypothesis .