Saint Luke's Hospital of Kansas City, Kansas City, Missouri, USA.
Pharmacotherapy. 2024 Aug;44(8):623-630. doi: 10.1002/phar.4600. Epub 2024 Jul 30.
A mainstay in the acute management of diabetic ketoacidosis (DKA) is fluid resuscitation. Normal saline is recommended by the American Diabetes Association; however, it has been associated with hyperchloremic metabolic acidosis and acute kidney injury. Limited literature is available to determine the most appropriate crystalloid fluid to treat patients with DKA.
The purpose of this study was to compare lactated Ringer's (LR) to normal saline (NS) in the acute management of DKA.
This was a retrospective, multicenter single health system cohort study. The primary outcome was to evaluate the time to high anion gap metabolic acidosis (HAGMA) resolution using LR compared to NS. Secondary outcomes included the incidence of nongap metabolic acidosis, hyperchloremia, acute kidney injury, and new renal replacement therapy. Other secondary outcomes included insulin infusion duration and hospital and intensive care unit length of stay. The Cox proportional hazards model was used for the primary outcome.
A total of 771 patient encounters were included. Lactated Ringer's was associated with faster time to HAGMA resolution compared to NS (adjusted hazard ratio 1.325; 95% confidence interval 1.121-1.566; p < 0.001). No difference was found in complications such as incidence of nongap metabolic acidosis, hyperchloremia, acute kidney injury, and new renal replacement therapy between the LR and NS groups. Additionally, there was no difference in insulin infusion duration and hospital or intensive care unit length of stay.
Treatment with LR as the primary crystalloid for acute DKA management was associated with faster HAGMA resolution compared with NS. Similar incidence in complications and length of stay was observed between the two groups. The findings of this study add to the accumulating literature suggesting that balanced crystalloids may offer an advantage over NS for the treatment of patients with DKA.
在糖尿病酮症酸中毒（DKA）的急性治疗中，液体复苏是主要手段。美国糖尿病协会推荐使用生理盐水；然而，它与高氯代谢性酸中毒和急性肾损伤有关。目前可用的文献有限，无法确定最适合治疗 DKA 患者的晶体液。
本研究旨在比较乳酸林格氏液（LR）和生理盐水（NS）在 DKA 急性治疗中的作用。
这是一项回顾性、多中心、单一医疗系统队列研究。主要结局是评估使用 LR 与 NS 相比，高阴离子间隙代谢性酸中毒（HAGMA）的缓解时间。次要结局包括非间隙代谢性酸中毒、高氯血症、急性肾损伤和新的肾脏替代治疗的发生率。其他次要结局包括胰岛素输注持续时间以及住院和重症监护病房的住院时间。使用 Cox 比例风险模型进行主要结局分析。
共纳入 771 例患者。与 NS 相比，LR 组 HAGMA 缓解时间更快（调整后的危险比 1.325；95%置信区间 1.121-1.566；p<0.001）。LR 组与 NS 组在非间隙代谢性酸中毒、高氯血症、急性肾损伤和新的肾脏替代治疗等并发症的发生率上无差异。此外，胰岛素输注时间和住院或重症监护病房的住院时间也无差异。
与 NS 相比，在 DKA 急性治疗中使用 LR 作为主要晶体液与更快的 HAGMA 缓解相关。两组之间在并发症发生率和住院时间方面观察到相似的结果。本研究的结果增加了越来越多的文献，表明平衡晶体液在治疗 DKA 患者方面可能优于 NS。
