104-LB: Glucose-Insulin-Potassium (GIK) as a Proposed Treatment for Normoglycemic Diabetic Ketoacidosis: An Old Friend for a New Foe?

Abstract

Introduction: Glucose, Insulin, and potassium (GIK) infusions were introduced into medical practice to reduce myocardial injury during a heart attack in 1962. Euglycemic diabetic ketoacidosis (EDKA) is a clinical triad comprising increased anion gap metabolic acidosis, ketonemia or ketonuria and blood glucose levels <250mg/dL. Based on common treatment delays due lack of hyperglycemia, we decided to start a new proposed protocol for patients with confirmed EDKA that included the use of GIK and compared them with historical controls before the protocol was established. GIK solution was prepared with Dextrose 5% solution 500 cc, 10 UI of short acting insulin al 10 mmol KCl. At al initial rate of 100 ml/hr. Objectives: Describe general characteristics and compare time to remission, length of ICU stay and length of hospital time between patients with SGLT2i-associated EDKA in whom GIK was used compared to standard care. Design: A Cohort study was designed to compare objectives between EDKA patients treated with a GIK-adapted protocol versus previous patients treated with standard of care of DKA. Patients and Methods: 4 Patients with EDKA treated with new protocol were compared with 7 previous patients treated with ADA recommendations for DKA. Results: 41.66% of patients were male, type 2 diabetes was initially diagnosed in 66.66% of patients. No differences in ER characteristics between standard vs. GIK group. The use of GIK as an add-on treatment to standard care was associated with a significant lower time to resolution (1.5±0.5 vs. 3.57±1.61, p<0.01), fewer ICU days (2.5±0.57 vs. 5.57±1.98, p<0.01), in-hospital days (4.5±0.577 vs. 11.85±3.43, p<0.01). No differences in hypoglycemic or hipo/hyperkalemia were found. Conclusions: With the wide use of SLGT2 inhibitors there has been a similar increase in the number of SGLT2i-associated EDKA. Were propose a different way of management of these patients. More research is needed in this field and entity. Disclosure D. Espinoza-Peralta: None. J. Monjardin-Rochin: None. M.E. Búrquez-González: None. L.G. Mireles-Zavala: None.