Skip to main content

Main menu

  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us

Clinical Medicine Journal

  • ClinMed Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About ClinMed
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

User menu

  • Log in

Search

  • Advanced search
RCP Journals
Home
  • Log in
  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us
Advanced

Clinical Medicine Journal

clinmedicine Logo
  • ClinMed Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About ClinMed
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

Response

Punith Kempegowda
Download PDF
DOI: https://doi.org/10.7861/clinmedicine.18-1-111
Clin Med February 2018
Punith Kempegowda
Health Education West Midlands and honorary research fellow, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
Roles: Specialist registrar in diabetes, endocrinology and general internal medicine
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Info & Metrics
Loading

We thank Mr Jolobe for his comments. It raises an interesting question relating to the fluid management of patients in DKA who are at an increased risk of overload (those with heart failure, renal failure or liver failure). The Joint British Diabetes Society guideline1 does not suggest any alternative fluid management strategies for patients with end organ damage. To our knowledge, there has not been any work done to assess the management of DKA specifically in these patient cohorts to see if clinicians opted for personalised fluid strategies for these patients and if so, whether this had an impact on prognosis.

To explore this further, on our original dataset 2 we conducted a subgroup analysis to assess for any differences in the management of fluids of patients with end organ failure, which was presented at the 2017 Diabetes UK conference.3 Using blood test results and clinical documentation we identified four groups:

  • patients without established organ damage (ie those not at an obvious risk of fluid overload) (n=197)

  • patients with heart failure (n=8)

  • patients with liver failure (n=11)

  • patients with renal failure (n=39).

In comparison, median values of appropriateness of fluid management in comparison to the JBDS guidelines were 100%, 90%, 80% and 80% in the four groups respectively. Using unequal t-tests these values were not significantly different to one another, suggesting there was not actually variation in the practice of early fluid prescription during the management of DKA. Although limitations persist in terms of case identification and sample size, this is an attempt to assess whether clinicians are considering the risk of fluid overload in these high-risk patients. We certainly believe further research should be done to explore the appropriate management of fluid in patients with end organ damage.

  • © Royal College of Physicians 2018. All rights reserved.

References

  1. ↵
    1. Savage MW
    , Dhatariya KK, Kilvert A, et al. Joint British Diabetes Societies guideline for the management of diabetic ketoacidosis. Diabet Med 2011;28:508–15.
    OpenUrlCrossRefPubMed
  2. ↵
    1. Kempegowda P
    , Coombs B, Nightingale P, et al. Regular and frequent feedback of specific clinical criteria delivers a sustained improvement in the management of diabetic ketoacidosis. Clin Med 2017;17:389–94.
    OpenUrlAbstract/FREE Full Text
  3. ↵
    1. Chandan JS
    , Kempegowda P, Shyamanur B, et al. Managing patients with diabetic ketoacidosis with established organ damage at a large teaching hospital in the West Midlands. Diabet Med 2017;34(S1):184–8.
    OpenUrl
Back to top
Previous articleNext article

Article Tools

Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Citation Tools
Response
Punith Kempegowda
Clinical Medicine Feb 2018, 18 (1) 111; DOI: 10.7861/clinmedicine.18-1-111

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Response
Punith Kempegowda
Clinical Medicine Feb 2018, 18 (1) 111; DOI: 10.7861/clinmedicine.18-1-111
Reddit logo Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • References
  • Info & Metrics

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • A systems approach can help improve patient flow in the NHS this winter and beyond
  • Letters to the Editor
  • Letters to the Editor
Show more Letters to the editor

Similar Articles

FAQs

  • Difficulty logging in.

There is currently no login required to access the journals. Please go to the home page and simply click on the edition that you wish to read. If you are still unable to access the content you require, please let us know through the 'Contact us' page.

  • Can't find the CME questionnaire.

The read-only self-assessment questionnaire (SAQ) can be found after the CME section in each edition of Clinical Medicine. RCP members and fellows (using their login details for the main RCP website) are able to access the full SAQ with answers and are awarded 2 CPD points upon successful (8/10) completion from:  https://cme.rcplondon.ac.uk

Navigate this Journal

  • Journal Home
  • Current Issue
  • Ahead of Print
  • Archive

Related Links

  • ClinMed - Home
  • FHJ - Home
clinmedicine Footer Logo
  • Home
  • Journals
  • Contact us
  • Advertise
HighWire Press, Inc.

Follow Us:

  • Follow HighWire Origins on Twitter
  • Visit HighWire Origins on Facebook

Copyright © 2021 by the Royal College of Physicians