IVF in DKA & HHNK

Q: Infusion of intravenous (IV) saline in Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) serves two main purposes. One is to expand the extracellular volume to achieve euvolemia. What is the second? 


Answer:  Increase of insulin responsiveness.

IV fluid infusion is the most important first treatment required in DKA and HHS (also known as hyperosmotic hyperglycemic nonketotic state - HHNK). Indeed, it achieves the primary goal of expanding vascular volume but a relatively less known effect is the increase of insulin responsiveness. This occurs via three mechanisms 

•  lowering of plasma osmolality 
• lowering the vasoconstriction  & improving perfusion 
• lowering the stress hormone levels

#endocrinology

References:

1. Bratusch-Marrain PR, Komajati M, Waldhausal W. The effect of hyperosmolarity on glucose metabolism. Pract Cardiol 1985; 11:153. 

2. Kitabchi AE, Umpierrez GE, Murphy MB. Diabetic ketoacidosis and hyperglycemic hypersmolar state. In: International Textbook of Diabetes Mellitus, 3rd, DeFronzo RA, Ferrannini E, Keen H, Zimmet P (Eds), John Wiley & Sons, Chichester, UK 2004. p.1101.