Disorders of carbohydrate metabolism in critical conditions
Objective. To characterize the features of the occurrence and treatment of disorders of carbohydrate metabolism in critical conditions.
Materials and methods. The search of publications was conducted using the engines PubMed and Google Scholar and analyzed the available domestic literature sources on the topics: carbohydrate metabolism disorders and critical conditions.
Results and discussion. In critical conditions, the following disorders of carbohydrate metabolism develop: diabetic and non-diabetic ketoacidosis, hyperosmolar syndrome, hypoglycemia and lactic acidosis. Carbohydrate disorders in critical conditions develop against the background of the underlying disease, masked by it and worsen the patient’s condition. To diagnose these conditions, a nitroprusside ketonuria test is often used, which does not reflect the actual level of ketonuria (β-oxybutyric acid) and responds to their level in a delayed manner, so most ketosis is diagnosed late – in a decompensated state. Therefore, it is necessary to be guided first of all by a condition of the patient and clinical signs of existence of ketoacidosis. Xylitol (Xylat) solutions are used to treat these conditions. It is believed that xylitol has the greatest antiketogenic effect among all known substances. In particular, Xylat reduces the amount of free fatty acids; increasing of the formation of pyruvic acid, which promotes the oxidation of acetyl-coenzyme A in the Krebs cycle; enhances glycogen production in the liver; stimulates insulin secretion. Do not wait for the appearance of “4+” acetone in the urine analysis. If the patient has nausea, vomiting, dizziness, drowsiness, dry skin and dry mouth, deep noisy breathing and frequent urination on the background of hyperglycemia (>13.9 mmol/l) – should use xylitol-containing drug (Xylat) at a dose of 6-10 ml/kg intravenously.
Clinical case. Patient M., 67 years old, was admitted to the trauma department with a hip fracture. He was treated conservatively (skeletal traction) for 3 weeks. Sudden deterioration of state of health is registered: periodically non-contact, loses consciousness. Blood pressure is not determined, heart rate cannot be calculated due to high frequency. On ECG – ventricular tachycardia. Bolus administration of amiodarone had no effect. Carefully analyzed history (diabetes does not get sick, but 3 weeks did not eat enough, almost starved). The level of glycemia is 5.2 mmol/l, ketonemia is 8.4 mmol/l (N=1.7 mmol/l). Diagnosed with non-diabetic ketoacidosis. Xylat infusion (7.5 ml/kg) was performed and amiodarone was reintroduced. As a result, sinus rhythm was restored, the patient regained consciousness.
Conclusions. With the development of critical conditions, patients often have disorders of carbohydrate metabolism, which are often stopped by the introduction of xylitol (Xylat).
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