Littérature scientifique sur le sujet « Chetoacidosi »

During the onset of diabetic ketoacidosis (DKA), the appearance of hyperchromic urines is a rare occurrence even if already described in the literature. The patient with DKA presents an increased risk to suffer of macrohaematuria due to nephrolithiasis (associated or not with urinary tract infections) and renal vein thrombosis. False macrohaematuria in rhabdomyolysis with myoglobinuria can also occur. This paper describes a case of an 11-year-old boy with severe onset of DKA, with macrohaematuria from kidney stones. The causes of nephrolithiasis in children with DKA are also reported.

The aim of the present work is to report preliminary results about the administration of an insulin analogue, LisPro, to treat diabetic chetoacidosis. This new procedure, in respect to insulin continuous infusion, allow significant cost reduction in terms of medical and nurses time dedicated to the patient and hospitalization length. In our experience, LisPro treatment compared to the standard of care, has allowed hospital time reduction of 2,1 days per patient. This can be translated in cost saving of about 700,00 euro per case. These preliminary data, replicating the results coming from published international experiences, have to be confirmed in our country through the implementation of more representative studies

Complications induced by treatment of diabetic ketoacidosis (DKA) usually result from overly aggressive therapy, inadequate animal monitoring, and failure to reevaluate biochemical parameters in a timely manner. The thesis is divided into 6 studies focusing on new therapeutic and monitoring approaches during DKA treatment. Chapter 2 is an introduction to the topic and summarizes the current state of the art on DKA. Chapter 3 reports a study aimed at investigating the efficacy and safety of intravenous infusion of Lispro insulin in cats demonstrating that its use is associated with few side effects and the same effectiveness compared to regular insulin. Next up, two studies investigated the accuracy and precision of a glucometer (Gluco Calea, WellioVet) and a glucose-ketones meter (Belua, WellioVet) in dogs (Chapter 4) and cats (Chapter 5). Neither device is sufficiently accurate for use in dogs, while the superior performance of Belua glucometer support its clinical use in cats. In recent years, there has been great interest in devices measuring interstitial glucose. The aims of the study in Chapter 6 were to assess the performance of the FreeStyle Libre in dogs with DKA, and to determine the effect of body condition score (BCS), lactate concentration, severity of ketosis and acidosis on its accuracy. Although the ISO 15197:2013 criteria being only partially fulfilled, the clinical accuracy of the FreeStyle, unaffected by metabolic variables, supports its use. The effect of BCS requires further investigation. Finally, the thesis reports a study whose objective was to investigate which parameter between urinary acetoacetate (AcAc) and blood 3-beta-hydroxybutyrate (3-HB) was more suitable to define the end-point for insulin therapy during the treatment of DKA in dogs. The use of blood 3-HB does not reduce the time of insulin infusion and the time of hospitalization (Chapter 7).
Le complicazioni secondarie al trattamento della chetoacidosi diabetica (DKA) sono generalmente conseguenti ad una terapia troppo aggressiva, ad un monitoraggio clinico inadeguato, oppure all’impossibilità di rivalutare sistematicamente alcuni parametri laboratoristici. La tesi si articola in 6 studi incentrati sulle nuove prospettive terapeutiche e di monitoraggio in corso di trattamento. Il Capitolo 2 costituisce un’introduzione all’argomento e riassume l’attuale stato dell’arte sulla DKA. Nel Capitolo 3 è riportato uno studio il cui scopo era indagare l’efficacia e la sicurezza dell’infusione endovenosa di insulina Lispro nella specie felina, dimostrando che il suo impiego è associato a minori effetti collaterali e alla stessa efficacia rispetto all’insulina regolare. A seguire, due studi hanno indagato l’accuratezza e la precisione di un glucometro (Gluco Calea, WellionVet) e di un glucometro/chetometro (Belua, WellionVet) nel cane (Capitolo 4) e nel gatto (Capitolo 5). Nessuno dei due dispositivi è risultato sufficientemente accurato da consentirne un utilizzo sicuro nel cane; diversamente, le superiori performance del glucometro Belua supportano l’impiego clinico nel gatto. Recentemente, è stato rivolto un grande interesse nei confronti dei dispositivi che misurano il glucosio interstiziale. Gli obiettivi dello studio riportato nel Capitolo 6 erano indagare le performance del FreeStyle Libre in cani con DKA e determinare l’effetto esercitato dal body condition score (BCS), dalla lattatemia, dalla gravità della chetosi e dell’acidosi sulla sua accuratezza. Sebbene i criteri ISO 15197:2913 siano stati solo parzialmente soddisfatti, l’accuratezza clinica del FreeStyle, non compromessa dalle variabili metaboliche, ne supporta l’impiego clinico. L’influenza esercitata dal BCS merita ulteriori indagini. Infine, è riportato uno studio il cui obiettivo era indagare quale parametro tra AcAc urinario e 3-HB ematico fosse più idoneo per definire l’endpoint della terapia insulinica in corso di trattamento della DKA nel cane. Lo studio dimostra che l’impiego del 3-HB non riduce la durata dell’infusione insulinica e dell’ospedalizzazione (Capitolo 7).