29-10-2024 | Research Letter
A modified total body water deficit formula for use in diabetes care
Author:
Philip J. G. M. Voets
Published in:
Diabetologia
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Excerpt
To the Editor: Total body water (TBW) balance and glycaemic regulation in the human body are closely intertwined [
1,
2]. During glycaemic dysregulation, a large TBW deficit ensues, primarily as a result of osmotic diuresis [
1,
2]. The most serious, potentially life-threatening complications of diabetes mellitus, that is, diabetic ketoacidosis (DKA) and hyperosmotic hyperglycaemic syndrome (HHS), produce, on average, TBW deficits of 6–7 l and 9–10 l, respectively [
1,
2]. Rational fluid resuscitation is therefore one of the cornerstones of the management of HHS and, to a slightly lesser extent, DKA [
1‐
3]. Because there is no ‘gold standard’ approach for determining an individual’s TBW status, clinicians use predictive formulas to estimate the TBW deficit [
3]. The best-known example of these TBW deficit formulas is shown in Equation (
1), which is derived from the change in plasma sodium concentration (
\({\left[N{a}^{+}\right]}_{p}\)) from a target concentration (i.e. 140 mmol/l) due to a change in TBW with respect to the original TBW, as estimated by measured body weight (
\(W\)) [
3]:
$$TBW\;deficit=0.6W\left(\frac{{\left[Na^+\right]}_p}{140}-1\right)$$
(1)
…