Gamba G, Oseguera J, Castrejón M, Gómez-Pérez F J
Department of Nephrology and Mineral Metabolism, Instituto Nacional de la Nutrición, Salvador Zubirán, México.
Rev Invest Clin. 1991 Jul-Sep;43(3):234-8.
Intravenous sodium bicarbonate has been used for a long time in the treatment of diabetic ketoacidosis. However, there are no clinical studies showing its effectiveness in improving arterial pH in this condition. We therefore designed this study to investigate if bicarbonate therapy improves the rate of increase of arterial pH and to find out its effects on the recovery rate of the other metabolic abnormalities. Twenty patients with severe diabetic ketoacidosis (pH less than 7.15) entered a double-blind, randomized, placebo controlled trial: nine were included in the bicarbonate group and eleven in the placebo group. All patients were studied during the first 24 hours of treatment. Their management was similar, except for the use of sodium bicarbonate in one group and 0.9% saline solution in the placebo group. Heart rate, respiratory rate, arterial pressure, mental status, blood gases, blood glucose, sodium, potassium, and urea were assessed at the beginning of treatment, and then at 2, 6, 12 and 24 hours. No clinical or metabolic differences were found between groups. Two hours after therapy was begun, the arterial pH rose in the bicarbonate group from 7.05 +/- 0.08 to 7.24 +/- 0.04, while it only rose from 7.04 +/- 0.08 to 7.11 +/- 0.09 in the placebo group (p less than 0.02). Simultaneously, arterial bicarbonate increased from 2.87 +/- 1.2 to 6.1 +/- 1.5 mEq/L in the bicarbonate group and from 2.55 +/- 0.81 to 3.6 +/- 2 mEq/L in the placebo group (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
静脉注射碳酸氢钠长期以来一直用于治疗糖尿病酮症酸中毒。然而，尚无临床研究表明其在此种情况下改善动脉血pH值的有效性。因此，我们设计了本研究以调查碳酸氢盐治疗是否能提高动脉血pH值的上升速率，并了解其对其他代谢异常恢复速率的影响。20例重度糖尿病酮症酸中毒（pH值小于7.15）患者进入一项双盲、随机、安慰剂对照试验：9例纳入碳酸氢盐组，11例纳入安慰剂组。所有患者在治疗的头24小时内接受研究。除一组使用碳酸氢钠而安慰剂组使用0.9%盐水溶液外，两组患者的治疗管理相似。在治疗开始时以及之后的2、6、12和24小时评估心率、呼吸频率、动脉压、精神状态、血气、血糖、钠、钾和尿素。两组之间未发现临床或代谢差异。治疗开始两小时后，碳酸氢盐组的动脉血pH值从7.05±0.08升至7.24±0.04，而安慰剂组仅从7.04±0.08升至7.11±0.09（p＜0.02）。同时，碳酸氢盐组的动脉血碳酸氢盐从2.87±1.2升至6.1±1.5 mEq/L，安慰剂组从2.55±0.81升至3.6±2 mEq/L（p＜0.01）。（摘要截选至250词）
