TIME COURSE OF RED BLOOD CELL DEFORMABILITY DURING DIABETIC KETOACIDOSIS

Abstract

Background : Diabetic ketoacidosis (DKA) is a life-threatening emergency. Microvascular hyporeactivity has been reported in these patients and is completely reversible when acidosis is corrected with aggressive treatment. The shape of the red blood cell (RBC), a sensor of local hypoxia and a component of the microcirculation, is altered in diabetic patients, but no data are available concerning RBC deformability in DKA during treatment. Methods : In this prospective observational study, we included all adult patients admitted with DKA to a 32-bed medico-surgical intensive care unit (ICU) over a 6-month period. We excluded patients with infection. We measured RBC deformability in the DKA patients and compared results with those from patients with type 1 diabetes and from a group of healthy volunteers (HV). RBC deformability was assessed using ektacytometry. In the DKA patients, it was assessed at ICU admission, 8 and 24 h after admission, and prior to ICU discharge (48-72 h). The RBC elongation index (EI) was determined based on the laser diffraction pattern changes. A higher EI indicates greater RBC deformability. Results : A total of 46 diabetic patients (15 DKA and 31 type 1 diabetes patients) and 20 HV were included. RBC deformability was more altered at ICU admission in DKA patients, with significantly lower EI values than in the other groups, and these alterations persisted during the ICU stay despite treatment. There were no correlations between these alterations and the quantity of fluids or insulin received. Conclusions : In contrast to the reversible microvascular hyporeactivity observed in DKA, RBC deformability was already altered at ICU admission in patients with DKA and remained altered despite treatment. These alterations may contribute to the blood flow abnormalities observed in these patients.

Keywords: BUN—blood urea nitrogen (BUN); CRP—C-reactive protein; DKA—diabetic ketoacidosis (DKA); DM1—diabetic patients; DM—diabetes mellitus; Diabetes mellitus; EI—elongation index; HV—healthy volunteers; HbA1c—glycosylated hemoglobin; Hb—hemoglobin concentration; Hct—hematocrit; ICU—intensive care unit; IV—intravenous; LORRCA—laser-assisted optical rotational red cell analyzer; MCV—mean corpuscular volume; OS—oxidative stress; Pa—pascal; RBC—red blood cell; SD—standard deviation; SS—shear stress; ektacytometry; microcirculation; microvascular; rheology.