Tamzil Rozinadya, Yaacob Normalinda, Noor Norhayati Mohd, Baharuddin Kamarul Aryffin
Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia.
Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia.
Turk J Emerg Med. 2023 Jun 26;23(3):131-138. doi: 10.4103/tjem.tjem_355_22. eCollection 2023 Jul-Sep.
The first-line treatment of diabetes ketoacidosis (DKA) involves fluid resuscitation with normal saline infusion to correct hypovolemia. Hyperchloremic metabolic acidosis from aggressive normal saline administration was associated with worse clinical outcomes in managing DKA. Other choices for normal saline include balanced electrolyte solutions (BESs). This study aimed to compare the clinical effects between BESs and normal saline in managing DKA. This study was a systematic review of probing articles published from inception to October 2021 in Cochrane Central Register of Controlled Trials, Medical Literature Analysis and Retrieval System Online, Google Scholar, and Scopus. Eight randomized controlled trials with a total of 595 individuals were included. The data were analyzed at 95% confidence level using random-effects models. For the primary outcomes, there was no difference in the duration of DKA resolution. (Mean difference [MD] -4.73, 95% confidence interval [CI] -2.72-4.92; = 92%; = 0.180). However, there was a significantly lower postresuscitation chloride concentration in the BES (MD 2.96 95% CI - 4.86 to - 1.06; = 59%; = 0.002). For the secondary outcomes, there was a significant reduction in duration for normalization of bicarbonate in the BES group (MD 3.11 95% CI - 3.98-2.23; = 5%; = 0.0004). There were no significant differences between groups in duration for recovery of pH, intensive unit admission, and adverse events (mortality and acute renal failure). Resuscitation with BES was associated with decreased chloride and increased bicarbonate values in DKA patients. It suggests that BES prevents DKA patients from hyperchloremic metabolic acidosis.
糖尿病酮症酸中毒（DKA）的一线治疗包括输注生理盐水进行液体复苏以纠正血容量不足。积极输注生理盐水导致的高氯性代谢性酸中毒与DKA治疗中更差的临床结局相关。生理盐水的其他替代选择包括平衡电解质溶液（BESs）。本研究旨在比较BESs和生理盐水在治疗DKA中的临床效果。本研究是一项系统评价，检索了从创刊至2021年10月发表在Cochrane对照试验中心注册库、医学文献分析与检索系统在线数据库、谷歌学术和Scopus上的相关文章。纳入了8项随机对照试验，共595例个体。使用随机效应模型在95%置信水平下对数据进行分析。对于主要结局，DKA缓解持续时间无差异（平均差[MD] -4.73，95%置信区间[CI] -2.72至4.92；I² = 92%；P = 0.180）。然而，BES组复苏后氯浓度显著更低（MD 2.96，95% CI -4.86至-1.06；I² = 59%；P = 0.002）。对于次要结局，BES组碳酸氢盐恢复正常的持续时间显著缩短（MD 3.11，95% CI -3.98至-2.23；I² = 5%；P = 0.0004）。两组在pH恢复持续时间、重症监护病房入住率和不良事件（死亡率和急性肾衰竭）方面无显著差异。用BES进行复苏与DKA患者氯降低和碳酸氢盐值升高相关。这表明BES可防止DKA患者发生高氯性代谢性酸中毒。
