静脉内碳酸氢钠治疗严重酸中毒的糖尿病酮症酸中毒。

Intravenous sodium bicarbonate therapy in severely acidotic diabetic ketoacidosis.

机构信息

Department of Pharmacy, University Hospital, University Health System, San Antonio, TX, USA.

出版信息

Ann Pharmacother. 2013 Jul-Aug;47(7-8):970-5. doi: 10.1345/aph.1S014. Epub 2013 Jun 4.

DOI:10.1345/aph.1S014

PMID:23737516

Abstract

BACKGROUND

The use of intravenous bicarbonate in diabetic ketoacidosis (DKA) may be considered for patients with a pH less than 6.9 according to the American Diabetes Association. The impact of this therapy on resolution of acidosis in patients with DKA is unclear.

OBJECTIVE

To determine whether the use of intravenous bicarbonate therapy was associated with improved outcomes in patients with severe DKA who were seen in the emergency department.

METHODS

This review was conducted from 2007 to 2011 in the emergency department of a tertiary teaching hospital. Adults diagnosed with DKA with an initial pH less than 7.0 were included. Patients were stratified into 2 groups based on receipt of intravenous bicarbonate. The primary study outcome was time to resolution of acidosis, defined as return to pH greater than 7.2. Secondary outcomes included length of stay; continuous infusion insulin use; and intravenous fluid, po tas si um, and insulin requirements within the first 24 hours of hospital admission, beginning upon admittance to the emergency department. We also conducted a subgroup analysis of patients with an initial pH less than 6.9.

RESULTS

There was no significant difference in time to resolution of acidosis (8 hours vs 8 hours; p = 0.7) or time to hospital discharge (68 hours vs 61 hours; p = 0.3) between patients who received intravenous bicarbonate (n = 44) compared with those who did not (n = 42). The median dose of intravenous bicarbonate was 100 mEq (100-150) for patients who received intravenous bicarbonate. Insulin and fluid requirements in the first 24 hours were significantly higher in patients who received intravenous bicarbonate compared with those who did not (100 units vs 86 units; p = 0.04 and 7.6 L vs 7.2 L; p = 0.01, respectively). There was no significant difference in hours of continuous insulin infusion (27 hours vs 26 hours; p = 0.09) or potassium requirements in the first 24 hours of hospital stay (135 mEq vs 120 mEq; p = 0.84).

CONCLUSIONS

Intravenous bicarbonate therapy did not decrease time to resolution of acidosis or time to hospital discharge for patients with DKA with an initial pH less than 7.0.

摘要

背景

根据美国糖尿病协会的建议，对于 pH 值低于 6.9 的糖尿病酮症酸中毒 (DKA) 患者，可以考虑使用静脉内碳酸氢盐。这种治疗方法对 DKA 患者酸中毒缓解的影响尚不清楚。

目的

确定在急诊科就诊的重度 DKA 患者中，使用静脉内碳酸氢盐治疗是否与改善预后相关。

方法

这项回顾性研究于 2007 年至 2011 年在一家三级教学医院的急诊科进行。纳入了初始 pH 值低于 7.0 的 DKA 成人患者。根据是否接受静脉内碳酸氢盐治疗，将患者分为 2 组。主要研究结局是酸中毒缓解的时间，定义为 pH 值恢复至大于 7.2。次要结局包括住院时间；持续输注胰岛素的使用；以及入院后 24 小时内的静脉补液、口服钾和胰岛素需求，从入住急诊科开始计算。我们还对初始 pH 值低于 6.9 的患者进行了亚组分析。

结果

与未接受静脉内碳酸氢盐治疗的患者（n=42）相比，接受静脉内碳酸氢盐治疗的患者（n=44）酸中毒缓解时间（8 小时 vs. 8 小时；p=0.7）或出院时间（68 小时 vs. 61 小时；p=0.3）无显著差异。接受静脉内碳酸氢盐治疗的患者静脉内碳酸氢盐的中位数剂量为 100 mEq（100-150）。与未接受静脉内碳酸氢盐治疗的患者相比，接受静脉内碳酸氢盐治疗的患者在入院后 24 小时内的胰岛素和液体需求显著更高（100 单位 vs. 86 单位；p=0.04 和 7.6 L vs. 7.2 L；p=0.01）。连续胰岛素输注时间（27 小时 vs. 26 小时；p=0.09）或住院期间前 24 小时内的钾需求（135 mEq vs. 120 mEq；p=0.84）无显著差异。