Catahay Jesus Alfonso, Polintan Edgar Theodore, Casimiro Michael, Notarte Kin Israel, Velasco Jacqueline Veronica, Ver Abbygail Therese, Pastrana Adriel, Macaranas Imee, Patarroyo-Aponte Gabriel, Lo Kevin Bryan
Faculty of Medicine and Surgery, University of Santo Tomas, Manila, Philippines.
Faculty of Medicine and Surgery, University of Santo Tomas, Manila, Philippines.
Heart Lung. 2022 Jul-Aug;54:74-79. doi: 10.1016/j.hrtlng.2022.03.014. Epub 2022 Mar 28.
Current guidelines suggest the use of isotonic saline (IS) infusion as the preferred resuscitation fluid in the management of diabetic ketoacidosis (DKA). However, balanced electrolyte solutions (BES) have been proposed as an alternative due to a lower propensity to cause hyperchloremic metabolic acidosis. Evidence regarding the use of BES in DKA remains limited.
To determine if the use of BES in fluid resuscitation leads to faster resolution of DKA compared to IS.
The study involves a comprehensive search of literature from PubMed, Cochrane CENTRAL, Google Scholar, and Science Direct of clinical trials addressing the use of BES vs IS in fluid resuscitation in DKA. The time to resolution of DKA was examined as the primary endpoint. Pooled hazard ratios (HR) and Mean Difference (MD) in hours with their 95% confidence intervals (CI) were calculated using a random-effects model.
The literature search included 464 studies that were screened individually. A total of 9 studies were identified but 6 studies were excluded due to irrelevance in the outcome of interest and target population. The pooled hazard ratio HR significantly revealed 1.46 [1.10 to 1.94] (p = 0.009) with 12% heterogeneity while MD was -3.02 (95% CI -6.78-0.74; p = 0.12) with heterogeneity of 85%.
Considering the evidence from pooled small randomized trials with moderate overall certainty of evidence, the use of BES in DKA was associated with faster rates of DKA resolution compared to IS.
当前指南建议在糖尿病酮症酸中毒（DKA）的治疗中，使用等渗盐水（IS）输注作为首选的复苏液体。然而，由于引起高氯性代谢性酸中毒的倾向较低，平衡电解质溶液（BES）已被提议作为一种替代方案。关于在DKA中使用BES的证据仍然有限。
确定与IS相比，在液体复苏中使用BES是否能更快地缓解DKA。
该研究全面检索了来自PubMed、Cochrane CENTRAL、谷歌学术和科学Direct的文献，这些文献涉及在DKA液体复苏中使用BES与IS的临床试验。将DKA缓解时间作为主要终点进行研究。使用随机效应模型计算合并风险比（HR）和以小时为单位的平均差（MD）及其95%置信区间（CI）。
文献检索包括464项单独筛选的研究。共确定了9项研究，但由于与感兴趣的结果和目标人群无关，排除了6项研究。合并风险比HR显著显示为1.46[1.10至1.94]（p = 0.009），异质性为12%，而MD为-3.02（95%CI -6.78 - 0.74；p = 0.12），异质性为85%。
考虑到来自合并的小型随机试验的证据，总体证据确定性中等，可以得出结论，在DKA中使用BES与比IS更快的DKA缓解率相关。
