Singhal Devanshi, Gupta Shalu, Kumar Virendra
Department of Pediatrics, Maulana Azad Medical College, and Associated Hospitals, New Delhi, India.
Division of Pediatric Critical Care, Department of Pediatrics, Lady Hardinge Medical College, and Kalawati Saran Children's Hospital, New Delhi, India.
Indian J Pediatr. 2024 Sep 20. doi: 10.1007/s12098-024-05240-9.
To compare normal saline (NS) and ringer's lactate (RL) as intravenous fluid therapy in children with diabetic ketoacidosis (DKA).
This was a triple blinded randomized controlled trial conducted in the Pediatric Intensive Care Unit (PICU) of a tertiary care hospital in New Delhi from November 2018 to March 2020. The study compared intravenous fluid therapy with ringer's lactate and normal saline in children aged 6 mo to 18 y with DKA as defined by The International Society for Pediatric and Adolescent Diabetes (ISPAD). The primary objective was comparing the time taken to achieve resolution of acidosis (pH ≥ 7.3) in both groups. Secondary objectives included comparing the proportion of patients that develop acute kidney injury; comparing the time taken for normalization of anion gap and blood glucose; time taken to change the type of fluid; total amount of fluid and insulin administered; and total length of PICU and hospital stay.
Fifty patients were enrolled, with 25 in each arm and all but one achieved the primary outcome. The median age of the patients was 9 (5, 12) y. The time taken for resolution of acidosis in patients treated with NS was 12 (4, 18) h and with RL was 8 (4, 10) h (p = 0.16). The NS group had a significantly higher incidence of hyperchloremia (p < 0.05) and longer PICU stay (p < 0.05). The metabolic profile and incidence of complications were comparable in both groups.
Ringer's lactate can safely be considered for the management of pediatric DKA and may be preferred in patients that are at a risk of complications due to hyperchloremia.
比较生理盐水（NS）和乳酸林格氏液（RL）作为糖尿病酮症酸中毒（DKA）患儿静脉补液疗法的效果。
这是一项三盲随机对照试验，于2018年11月至2020年3月在新德里一家三级护理医院的儿科重症监护病房（PICU）进行。该研究比较了国际儿童和青少年糖尿病协会（ISPAD）定义的6个月至18岁DKA患儿使用乳酸林格氏液和生理盐水进行静脉补液治疗的效果。主要目的是比较两组患儿酸中毒（pH≥7.3）得到纠正所需的时间。次要目的包括比较发生急性肾损伤的患者比例；比较阴离子间隙和血糖恢复正常所需的时间；改变补液类型所需的时间；补液和胰岛素的总用量；以及PICU住院时间和总住院时间。
共纳入50例患者，每组25例，除1例患者外均达到主要结局。患者的中位年龄为9（5，12）岁。使用NS治疗的患者酸中毒纠正时间为12（4，18）小时，使用RL治疗的患者为8（4，10）小时（p = 0.16）。NS组高氯血症的发生率显著更高（p < 0.05），PICU住院时间更长（p < 0.05）。两组的代谢指标和并发症发生率相当。
乳酸林格氏液可安全用于小儿DKA的治疗，对于有因高氯血症而发生并发症风险的患者可能更适用。
