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A randomized, controlled trial of oral versus intravenous fluids for lowering blood glucose in emergency department patients with hyperglycemia

Published online by Cambridge University Press:  04 March 2015

Sanjay Arora ,
Marc A. Probst ,
Laura Andrews ,
Marissa Camilion ,
Andrew Grock ,
Gregory Hayward  and
Michael Menchine
Sanjay Arora*
Affiliation:
Department of Emergency Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, CA
Marc A. Probst
Affiliation:
Department of Emergency Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, CA
Laura Andrews
Affiliation:
Department of Emergency Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, CA
Marissa Camilion
Affiliation:
Department of Emergency Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, CA
Andrew Grock
Affiliation:
Department of Emergency Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, CA
Gregory Hayward
Affiliation:
Department of Emergency Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, CA
Michael Menchine
Affiliation:
Department of Emergency Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, CA
*
Department of Emergency Medicine, Keck School of Medicine at the University of Southern California, 1200 North State Street, Room 1011, Los Angeles, CA 90033; [email protected]

Abstract

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Objectives:

Blood glucose can be lowered via insulin and/or fluid administration. Insulin, although efficacious, can cause hypoglycemia and hypokalemia. Fluids do not cause hypoglycemia or hypokalemia, but the most effective route of fluid administration has not been well described. This study compared the efficacy and safety of oral versus intravenous fluids for reducing blood glucose in patients with hyperglycemia.

Methods:

We conducted a prospective, nonblinded, randomized, controlled trial. Inclusion criteria were blood glucose > 13.9 mmol/L, age > 18 years, and ability to tolerate oral fluids. Subjects were excluded for critical illness, contraindication to fluids, and/or hyperglycemia therapy prior to enrolment. Subjects were randomized to receive oral bottled water or intravenous normal saline (maximum 2 L) over 2 hours. The primary outcome of interest was a change in blood glucose at 2 hours across treatment arms.

Results:

The 48 subjects were randomized. Baseline blood glucose levels and total amount of fluid received were similar between the two groups. The mean decrease in blood glucose at 2 hours was similar for both treatment arms: a mean decrease of 3.4 mmol/L (20.2 mmol/L to 16.8 mmol/L) in the oral fluid group versus a mean decrease of 4.0 mmol/L (19.7 mmol/L to 15.7 mmol/L) in the intravenous fluid group. The mean difference between groups was −0.6 mmol/L (95% confidence interval −2.3–1.2; p = 0.51). No adverse events were observed in either group.

Conclusion:

In this unblinded randomized trial, oral and intravenous fluids were equally efficacious in lowering blood glucose levels in stable hyperglycemic patients and no adverse events were noted. Physicians should be mindful that, although similar, the reduction in blood glucose was modest in both groups.

Keywords

diabetesfluid administrationhyperglycemia
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 16 , Issue 3 , May 2014 , pp. 214 - 219
Copyright
Copyright © Canadian Association of Emergency Physicians 2014

References

REFERENCES

1. Centers for Disease Control and Prevention, U.S. Department of Health and Human Services. National diabetes fact sheet. General information and national estimates on diabetes in the United States. Available at: (accessed June 29, 2011).Google Scholar
2. Public Health Agency of Canada. Report from the Canadian Chronic Disease Surveillance System: diabetes in Canada, 2009. Available at: (accessed September 2012).Google Scholar
3. Menchine, MD, Wiechmann, W, Peters, A, et al. Trends in diabetes-related visits to US EDs from 1997 to 2007. Am J Emerg Med 2012;30:754–8. [Epub 2011 May 12], doi:10.1016/j.ajem.2011.02.028.CrossRefGoogle ScholarPubMed
4. Ginde, AA, Pelletier, AJ, Camargo, CA Jr. National study of U.S. emergency department visits with diabetic ketoacidosis, 1993-2003. Diabetes Care 2006;29:2117–9, doi:10.2337/dc06-0627.CrossRefGoogle ScholarPubMed
5. Ginde, AA, Delaney, KE, Pallin, DJ, et al. Multicenter survey of emergency physician management and referral for hyperglycemia. J Emerg Med 2010;38:264–70, doi:10.1016/j.jemermed.2007.11.088.Google Scholar
6. Munoz, C, Villaneuva, G, Fogg, B, et al. Impact of subcutaneous insulin protocol in the emergency department: Rush Emergency Department Hyperglycemia Intervention. (REDHI). J Emerg Med 2011;40:493–8, doi:10.1016/j.jemermed.2008.03.017.Google Scholar
7. Arora, S, Cheng, D, Wyler, B, et al. Prevalence of hypokalemia in emergency department patients with diabetic ketoacidosis. Am J Emerg Med 2011 Feb 10. [Epub ahead ofprint]Google ScholarPubMed
8. Atia, AN, Buchman, AL. Oral fluid administration solutions in non-cholera diarrhea: a review. Am J Gastroenterol 2009;104:2596–60, doi:10.1038/ajg.2009.329.Google Scholar
9. American Academy of Pediatrics. Practice parameter: the management of acute gastroenteritis in young children. Pediatrics 1996;97:424–35.CrossRefGoogle Scholar
10. Hartling, L, Bellemare, S, Wiebe, N, et al. Oral versus intravenous fluid administration for treating dehydration due to gastroenteritis in children. Cochrane Database Syst Rev 2006;(3):CD004390.Google Scholar