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Neurological complications in diabetic ketoacidosis- before and after insulin therapy

Manmohan Krishna Pandey, Purnima Mittra, Jitendra Doneria, Pradeep Kumar Maheshwari.

Abstract
Background: Neurological complications in DKA may present before, during and after the therapy. Present study was designed to evaluate neurological complication in DKA and effects of insulin therapy.

Aims & Objective: To compare neurological complications of DKA before and after insulin therapy.

Material and Methods: This was Cross-Sectional Study with sample size of 40. 40 cases of diabetes mellitus in DKA were given standard treatment with intravenous insulin infusion and fluids. Patients were compared with the symptoms and signs of DKA before and 12 hours of insulin therapy. Result were analyzed with Graph Pad Software with paired t-test and discussed in terms of p-value.

Results: The general symptoms like pain in abdomen, thirst, nausea and vomiting and general signs of DKA like tachycardia, hypotension dry mucous membrane, dehydration and Kussmaul’s respiration showed clinically significant improvement and statistically very significant with p-value less than 0.05 after insulin infusion therapy. The CNS symptoms like headache, altered mentation, unconsciousness and abnormal verbal/motor response to pain increased after 12 hours of insulin infusion therapy and intravenous fluids and results were statistically significant with p-value 0.0221 and CNS signs of DKA i.e. bradycardia, extensor planter response, papilledema and third cranial nerve palsy showed clinically significant results but statistically not significant with p-value 0.0911 after insulin infusion therapy.

Conclusion: CNS manifestation of DKA may aggravate symptoms and signs with insulin infusion therapy. Patient should be monitored for CNS manifestations during therapy along with oxygen saturation, blood pressure, hydration and other vital parameters.

Key words: Diabetic Ketoacidosis, Central Nervous System, Cerebral Edema, Diabetes Mellitus



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