International Journal of Travel Medicine and Global Health

International Journal of Travel Medicine and Global Health

Targeting Ketone Burden in Diabetic Ketoacidosis: A Novel IV Infusion Linking Glycine Cleavage, Cofactor Optimization, and Antioxidant Defense

Articles in Press

Document Type : Perspective

Authors
Maher Akl 1
Amr Ahmed 2
1 MD Candidate, Faculty of Medicine, Novosibirsk State University, Russia. B.Sc. in Chemistry, Faculty of Science, Mansoura University, Egypt.
2 The public health department, Riyadh First Health Cluster, Ministry of Health, Saudi Arabia
10.30491/ijtmgh.2025.544662.1503
Abstract
Diabetic ketoacidosis (DKA) remains a critical emergency with 1–5% mortality and an annual U.S. healthcare burden >2 billion USD. Standard management (insulin, fluids, potassium, bicarbonate) halts ketogenesis but fails to accelerate ketone clearance, address oxidative stress, or replenish depleted cofactors imitations that prolong resolution (12–24 h) and hospital stays (3–4 days). We propose the DKA-Rescue IV infusion, a novel formulation combining Ringer’s lactate, sodium bicarbonate, potassium chloride, glycine, thiamine, and N-acetylcysteine (NAC). Glycine targets ketone burden via the mitochondrial glycine cleavage system, enhancing acetoacetate clearance by 30–40% in metabolic models. Thiamine (pyrophosphate form) activates pyruvate dehydrogenase, reducing lactate accumulation by ~25%, while NAC restores glutathione, lowering oxidative markers by up to 50%. Kinetic modeling predicts accelerated acidosis correction (pH from 6.9 to 7.3 within hours) and faster ketone elimination, potentially shortening recovery to 6–8 hours. Feasibility is supported by low production costs (8–15 USD/L) and physiologic osmolarity (280–310 mOsm/L). This framework redefines DKA as a treatable metabolic network disorder and warrants early-phase clinical trials to validate safety and efficacy.
Keywords
Diabetic ketoacidosis
intravenous infusion
glycine cleavage system
thiamine pyrophosphate
N-acetylcysteine
ketone metabolism
International Journal of Travel Medicine and Global Health

Articles in Press, Accepted Manuscript
Available Online from 09 May 2026

  • Receive Date 02 September 2025
  • Revise Date 05 October 2025
  • Accept Date 05 October 2025