Division of Emergency Medicine, Department of Pediatrics, Colorado Children's Hospital, University of Colorado-Denver School of Medicine, Aurora
Department of Emergency Medicine, University of California Davis Health, University of California, Davis, School of Medicine, Sacramento.
Diabetes Care. 2021 Sep;44(9):2061-2068. doi: 10.2337/dc20-3113. Epub 2021 Jun 29.
Fluid replacement to correct dehydration, acidosis, and electrolyte abnormalities is the cornerstone of treatment for diabetic ketoacidosis (DKA), but little is known about optimal fluid infusion rates and electrolyte content. The objective of this study was to evaluate whether different fluid protocols affect the rate of normalization of biochemical derangements during DKA treatment.
The current analysis involved moderate or severe DKA episodes ( = 714) in children age <18 years enrolled in the Fluid Therapies Under Investigation in DKA (FLUID) Trial. Children were assigned to one of four treatment groups using a 2 × 2 factorial design (0.90% or 0.45% saline and fast or slow rate of administration).
The rate of change of pH did not differ by treatment arm, but Pco increased more rapidly in the fast versus slow fluid infusion arms during the initial 4 h of treatment. The anion gap also decreased more rapidly in the fast versus slow infusion arms during the initial 4 and 8 h. Glucose-corrected sodium levels remained stable in patients assigned to 0.90% saline but decreased in those assigned to 0.45% saline at 4 and 8 h. Potassium levels decreased, while chloride levels increased more rapidly with 0.90% versus 0.45% saline. Hyperchloremic acidosis occurred more frequently in patients in the fast arms (46.1%) versus the slow arms (35.2%).
In children treated for DKA, faster fluid administration rates led to a more rapid normalization of anion gap and Pco than slower fluid infusion rates but were associated with an increased frequency of hyperchloremic acidosis.
纠正脱水、酸中毒和电解质异常的液体补充是治疗糖尿病酮症酸中毒（DKA）的基石，但对于最佳的液体输注速率和电解质含量知之甚少。本研究的目的是评估不同的液体方案是否会影响 DKA 治疗期间生化紊乱正常化的速度。
本分析纳入了年龄<18 岁的中度或重度 DKA 发作（=714）患者，这些患者来自于正在进行的 DKA 中液体治疗研究（FLUID）试验。使用 2×2 析因设计（0.90%或 0.45%生理盐水和快速或慢速输注）将儿童分配到四个治疗组之一。
治疗组之间 pH 值的变化率没有差异，但在治疗的最初 4 小时内，快速与慢速液体输注组相比，Pco 增加得更快。在最初的 4 和 8 小时内，快速与慢速输注组相比，阴离子间隙下降得更快。在分配到 0.90%生理盐水的患者中，葡萄糖校正后的钠水平保持稳定，但在分配到 0.45%生理盐水的患者中，4 和 8 小时时降低。钾水平下降，而与 0.45%生理盐水相比，0.90%生理盐水时氯离子水平更快增加。快速组（46.1%）比慢速组（35.2%）更频繁发生高氯性酸中毒。
在治疗 DKA 的儿童中，与慢速液体输注相比，更快的液体给药速度导致阴离子间隙和 Pco 更快地正常化，但与高氯性酸中毒的发生率增加相关。
