The Clinical Effect Of Hydroxyethyl Starch In The Treatment Of Diabetic Acute Dysmetabolic Syndrome

Diabetic ketoacidosis and diabetic hyperosmotic hyperglycemia syndrome were called diabetic acute dysmetabolic syndrome. They are two of the common complications responsible for high mortality in diabetes. One of the typical symptom of DKA and HHS is dehydration that causes hypovolemia and hypovolemic shock. The key treatment to it is fluid replacement to re-establish normal circulation and to improve tissue perfusion. Recent years, gastrointestinal resuscitation was successfully used in the treatment of diabetic acute dysmetabolic syndrome. However, polyuria, with urine output as much as 3000-6000ml/d occurred quite often after gastrointestinal resuscitation. Polyuria becomes a major problem in handling water and electrolyte balance. Middle molecular hydroxyethyl starch (HES) has been widely used in clinic to correct hypovolemic shock, nevertheless, it is clinical potential in handling water balance in diabetic acute dysmetabolic syndrome has not been investigated. To evaluate its effect in restoring water balance and correcting polyuria occurred during fluid resuscitation, a randomized controlled trail was carried out. 40 patients with diabetic acute dysmetabolic syndrome were divided into two groups, i.e. controland treatment group. Control group was given gastronintestinal resuscitation, while the treatment group was given HES intravenously. It was found that after 1-3 days of treatment, the mean urine output of each day in control group was 3238ml, 3866ml, 3493ml respectively, compared to the HES treated group whose mean urine output was 2167ml, 2452, 2138ml each day. The day intake fluid volume of control group was 6595ml, 4847ml, 4007ml in the first 3 days while the HES treated group only had 5218ml, 3522ml, 2448ml. The differences described above between two groups are statistically significant (P<0.01). These results indicated that using HES had reduced patient's urine output and fluid intake. Blood Na+, K+, Glucose and osmolarity of the two groups were also compared statistically. No difference was found (P>0.05), suggesting HES have no side effect in rising blood glucose. Blood creatinine level had obviously decresed after HES treatment (P<0.01), well indicate that the HES had additional effect in reducing blood creatinine level when patients received adequate fluid resuscitation. This work has proved that HES not only can prevent polyuria caused by diabetic acute dysmetabolic syndrome resulted from gastrointestinal resuscitation, but also causes no side effect.