Optimising risk stratification in diabetic ketoacidosis: a re-evaluation of acid-base status and hyperosmolarity using observational data.

Accurate assessment of severity in diabetic ketoacidosis (DKA) can optimise early management and facilitate prioritisation for high acuity care. The primary aim was to evaluate the relationship between severity of acidosis (considering pH, bicarbonate, and anion gap) and hyperosmolarity with hospital mortality. Secondary outcomes included intensive care mortality, mechanical ventilation, vasopressor/inotrope use, and dialysis.

Echocardiography Does not Reduce Mortality in Sepsis: A Re-Evaluation Using the Medical Information Mart for Intensive Care IV Dataset.

Objectives: Echocardiography is commonly used for hemodynamic assessment in sepsis, but data regarding its association with outcome are conflicting. The aim of this study was to evaluate the association between echocardiography and outcomes in patients with septic shock using the Medical Information Mart for Intensive Care IV database.

Design: Retrospective cohort study comparing patients who did or did not undergo transthoracic echocardiography within the first 5 days of admission for the primary outcome of 28-day mortality.

Mind the gap: Measured and Calculated Osmolarity are Not Interchangeable in Diabetic Hyperglycemic Emergencies.

Introduction: Small case series have reported that diabetic ketoacidosis is associated with an elevated osmolar gap, while no previous studies have assessed the accuracy of calculated osmolarity in the hyperosmolar hyperglycemic state. The aim of this study was to characterize the magnitude of the osmolar gap in these conditions and assess whether this changes over time.

Methods: In this retrospective cohort study, two publicly available intensive care datasets were used: Medical Information Mart of Intensive Care IV and the eICU Collaborative Research Database.

What Is the Optimal Speed of correction of the Hyperosmolar Hyperglycemic State in Diabetic Ketoacidosis? An Observational Cohort Study of U.S. Intensive Care Patients.

Objective: The international guidelines for the treatment of diabetic ketoacidosis (DKA) advise against rapid changes in osmolarity and glucose; however, the optimal rates of correction are unknown. We aimed to evaluate the rates of change in tonicity and glucose level in intensive care patients with DKA and their relationship with mortality and altered mental status.

Methods: This is an observational cohort study using 2 publicly available databases of U.