Salutary effects of modest fluid replacement in the treatment of adults with diabetic ketoacidosis: use in patients without extreme volume deficit

Article Abstract:

Whenever carbohydrates cannot be used by the body for energy, as in the case of diabetes mellitus, and when amino acids and fats are metabolized, ketones build up in the blood and urine, resulting in a condition known as ketoacidosis. The patient with this condition may develop a fruity or sweet smelling breath, and if the condition is allowed to persist, he may suffer from confusion, unconsciousness and may even die. In such cases the presence of ketones in the urine also causes a marked depletion in the volume of bodily fluids, which must be immediately treated by administering physiologic saline, a fluid with the same mineral and electrolyte content as body fluids. The current study examines the effect of restoration of body fluids using two different regimens on patients suffering from diabetic ketoacidosis. One group of patients received a course of treatment which replaced 1,000 ml per hour for the first hour and 500 ml per hour for four additional hours. The second group of patients followed the same method of administration of saline, but at a perfusion rate which was 50 percent lower. Ketoacidosis was relieved by the treatment in both groups, but there were advantages to the lower replacement rate, including more appropriate levels of bicarbonate, acid-base (pH) balance in the blood, and reduced possibility of edema, swelling caused by tissue fluid retention. Additionally the use of small quantities of fluid reduced the cost of treatment by approximately 3 liters of saline at a cost of approximately $10 to $15 per liter, for an annualized United States aggregate savings of $2.4 to $3.6 million. This estimate is based on approximately 80,000 cases of diabetic ketoacidosis per year in the United States.

Care and treatment, Usage, Laws, regulations and rules, Ketoacidosis, Diabetic ketoacidosis, Body fluids, Physiologic salines, Saline solution

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Prevalence, incidence of diabetes mellitus - United States, 1980-1987

Article Abstract:

This report describes trends in the prevalence of people who reported themselves as having diabetes mellitus (DM) in 1980 and 1987, during surveys conducted in those years. The number of people with DM increased by more than 17 percent between the years studied, from 5.8 million to 6.8 million. The number of white males with diabetes increased by approximately 33 percent; of black males, by 16 percent; and of black females, by 24 percent. The number of white females with DM remained essentially stable. The incidence of DM (new cases within a defined period of time) per 1,000 persons was 2.4 in 1980 and 2.9 in 1987, and was higher each year for blacks than for whites. People with DM have increased risks of cardiovascular disease, leg amputation, eye disease, serious kidney disease, and other complications. Furthermore, it is likely that the condition is severely underdiagnosed; thus, the health care costs related to DM will probably increase. Members of minority groups are at particular risk for DM and its complications. To reverse the trend toward increasing prevalence, better strategies for preventing noninsulin-dependent diabetes (NIDDM, the most common form of DM) will need to be developed. In this regard, obesity is believed to cause as many as half of all cases of NIDDM. The beneficial effects of weight reduction on DM have not been shown, however. (Consumer Summary produced by Reliance Medical Information, Inc.)

Reports, Prevention, Statistics, Demographic aspects, United States. Centers for Disease Control and Prevention

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Sildenafil for Treatment of Erectile Dysfunction in Men With Diabetes: A Randomized Controlled Trial

Article Abstract:

Diabetic men with impotence may benefit from treatment with sildenafil (Viagra). Researchers randomly assigned 252 diabetic men with impotence to take Viagra or a placebo one hour before sexual activity but no more than once a day for a 12-week period. After 12 weeks, 56% of the men taking Viagra reported improved sexual ability, compared to 10% of those in the placebo group. Men taking Viagra were more likely to experience side effects, which included headache, upset stomach, and sinus congestion or drainage.

Evaluation, Product/Service Evaluation, Drug therapy, Impotence, Viagra (Medication), Sildenafil

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