Peritoneal dialysis for the rescue in critical refractory metabolic acidosis in diabetic ketoacidosis

Exploring the Therapeutic Potential of Peritoneal Dialysis (PD) in the Treatment of Neurological Disorders

Peritoneal dialysis (PD) is a well-established renal replacement therapy commonly employed in clinical practice. While its primary application is in the treatment of kidney disease, its potential in addressing other systemic disorders, including neurological diseases, has garnered increasing interest. This study provides a comprehensive overview of the related technologies, unique advantages, and clinical applications of PD in the context of neurological disorders. By exploring the mechanism underlying PD, its application in neurological diseases, and associated complications, we addressed the feasibility and benefits of PD as an adjunct therapy for various neurological conditions. Our study aims to highlight its role in detoxification and symptom management, as well as its advantages over other universally accepted methods of renal replacement therapy. Our goal is to bring to the spotlight the therapeutic potential of PD in neurological diseases, such as stroke, stimulate further research, and broaden the scope of its application in the clinical setting.

Analysis of Related Factors of Early Mortality in Patients with Severe Renal Injury Treated with Continuous Venovenous Hemodialysis

Background. To explore the related factors of early mortality in patients with severe renal injury treated with continuous venovenous hemodialysis (CVVHD), this study is of great significance to improve the treatment effect of hemodialysis. Methods. Clinical data of 83 patients with severe renal injury who underwent CVVHD treatment in Nephrology Department of our hospital (January 1, 2017, to June 30, 2019) were retrospectively analyzed. Results. Mortality was the highest in the first month of CVVHD treatment and then decreased obviously. Early mortality was particularly higher in patients aged 60 and above. Age of first hemodialysis, cardio cerebrovascular diseases, serum phosphorus, urea nitrogen, blood calcium, platelet count, lean body mass (LBM), and total cholesterol were significant risk factors for early mortality. Conclusion. The early mortality of patients with severe renal injury during CVVHD treatment was higher.

Challenging Management of Refractory Metabolic Acidosis and Acute Kidney Injury in a Child with Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is the most serious complication of type I diabetes mellitus (DM) in children. Majority of these patients respond to fluid resuscitation, insulin, and supportive measures and rarely require renal replacement therapy. Here, we report the case of a young girl with DKA with severe refractory metabolic acidosis and acute kidney injury (AKI) and was successfully managed with renal replacement therapy.

How to cite this article: Jain R, Kumar P. Challenging Management of Refractory Metabolic Acidosis and Acute Kidney Injury in a Child with Diabetic Ketoacidosis. Indian J Crit Care Med 2020;24(6):475–476.

Acute mountain sickness induced diabetic ketoacidosis managed with hemodialysis: A case report

Introduction

The risk of developing ketoacidosis in patients with type 1 diabetes at high altitude is high. Anorexia associated with acute mountain sickness, dehydration and additional exercise associated with climbing exacerbates the generation of ketones and the development of ketoacidosis.

Case presentation

A 33-year-old gentleman with known history of uncontrolled type 1 diabetes mellitus trekked to Everest Base Camp at an altitude of 3440 m and became unwell. He developed altered sensorium and shortness of breath. He ingested eight tablets of acetazolamide (250 mg each) to address these symptoms. Upon presentation to emergency, he was diagnosed with severe diabetes ketoacidosis (DKA) with shock. Resuscitation was started with fluid, insulin, vasopressors and mechanical ventilation. Despite adequate fluid resuscitation, insulin, bicarbonates and other supportive measures, his acidosis and shock persisted and then managed with hemodialysis. After the first session of hemodialysis, improvement in acidosis and shock was noted. He was successfully extubated and later discharged.

Discussion

In this case report, DKA due to acute mountain sickness was complicated by acetazolamide use and noncompliance to his regular insulin intake. There is no proper guideline regarding the role of renal replacement therapy in management of DKA. However, evidence of hemodialysis in DKA is limited to few case reports. Improvement seen in our patient after dialysis is related to dialyzable nature of acetazolamide.

Conclusion

We present a case of a severe DKA potentially precipitated by acute mountain sickness, use of acetazolamide, noncompliance to his regular insulin intake and managed with hemodialysis in addition to conventional treatment for DKA.

•

Metabolic decompensation that occur with high altitude increases the generation of ketones and the development of ketoacidosis.

•

Incorporating renal replacement therapy in severe refractory acidosis in DKA management will reduce the morbidity and mortality in patient with DKA.

•

The timely intervention of dialysis in severe refractory acidosis has a good outcome.