Advertisement

Intensive Care Medicine

, Volume 44, Issue 7, pp 1185–1186 | Cite as

Euglycemic ketoacidosis, a common and underecognized complication of continuous renal replacement therapy using glucose-free solutions

  • Maxime Coutrot
  • Guillaume Hékimian
  • Thibaut Moulin
  • Nicolas Bréchot
  • Matthieu Schmidt
  • Sébastien Besset
  • Ania Nieszkowska
  • Guillaume Franchineau
  • Simon Bourcier
  • Olivier Bourron
  • Charles-Edouard Luyt
  • Alain Combes
Letter

Dear Editor,

Acute kidney injury (AKI) is a frequent and severe condition in intensive care unit patients that may require renal replacement therapy; most frequently continuous renal replacement therapy (CRRT). Phosphate-containing replacement fluids are glucose-free solutions commonly used to prevent hypophosphatemia [1]. If hypoglycemia is a well-known complication of their use in CRRT, euglycemic ketoacidosis (EKA) has never been described in this setting.

We prospectively screened all anuric patients receiving CRRT with glucose-free replacement solution, and included patients who had induced EKA between February and May 2017. Ketoacidosis was deemed possible when non-lactic metabolic acidosis did not improve in patients on CRRT. Because all patients were anuric, we measured ketonemia and used urinary test strips in the effluent fluid. EKA diagnosis was retained when arterial serum bicarbonate was < 20 mEq/l and decreased despite ongoing CRRT, in the absence of lactic acidosis and...

Notes

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.

Supplementary material

134_2018_5118_MOESM1_ESM.docx (16 kb)
Supplementary material 1 (DOCX 15 kb)

References

  1. 1.
    Besnard N, Serveaux M, Machado S et al (2016) Electrolytes-enriched hemodiafiltration solutions for continuous renal replacement therapy in acute kidney injury: a crossover study. Blood Purif 42:18–26.  https://doi.org/10.1159/000444248 CrossRefPubMedGoogle Scholar
  2. 2.
    Munro JF, Campbell IW, McCuish AC, Duncan LJ (1973) Euglycaemic diabetic ketoacidosis. Br Med J 2:578–580CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Modi A, Agrawal A, Morgan F (2017) Euglycemic diabetic ketoacidosis: a review. Curr Diabetes Rev 13:315–321.  https://doi.org/10.2174/1573399812666160421121307 CrossRefPubMedGoogle Scholar
  4. 4.
    Joseph F, Anderson L, Goenka N, Vora J (2009) Starvation-induced true diabetic euglycemic ketoacidosis in severe depression. J Gen Intern Med 24:129–131.  https://doi.org/10.1007/s11606-008-0829-0 CrossRefPubMedGoogle Scholar
  5. 5.
    Ricci Z, Ronco C (2011) Timing, dose and mode of dialysis in acute kidney injury. Curr Opin Crit Care 17:556–561.  https://doi.org/10.1097/MCC.0b013e32834cd360 CrossRefPubMedGoogle Scholar
  6. 6.
    Stevenson JM, Heung M, Vilay AM et al (2013) In vitro glucose kinetics during continuous renal replacement therapy: implications for caloric balance in critically ill patients. Int J Artif Organs 36:861–868.  https://doi.org/10.5301/ijao.5000232 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2018

Authors and Affiliations

  • Maxime Coutrot
    • 1
  • Guillaume Hékimian
    • 1
  • Thibaut Moulin
    • 1
  • Nicolas Bréchot
    • 1
  • Matthieu Schmidt
    • 1
  • Sébastien Besset
    • 1
  • Ania Nieszkowska
    • 1
  • Guillaume Franchineau
    • 1
  • Simon Bourcier
    • 1
  • Olivier Bourron
    • 1
  • Charles-Edouard Luyt
    • 1
  • Alain Combes
    • 1
  1. 1.Hopital Universitaire Pitie SalpetriereParisFrance

Personalised recommendations