Rother K I, Schwenk W F
Section of Pediatric Endocrinology and Metabolism, Mayo Clinic Rochester, MN 55905.
Mayo Clin Proc. 1994 Dec;69(12):1149-53. doi: 10.1016/s0025-6196(12)65766-8.
To evaluate whether rehydration of young patients with diabetic ketoacidosis (DKA) by use of a solution that contained 75 mmol/L of sodium would be associated with a decline in serum sodium concentrations.
We retrospectively studied 18 episodes of moderate to severe DKA (mean plasma bicarbonate concentration of 7.8 +/- 0.9 mmol/L) in 17 patients younger than 18 years of age who had been examined at the Mayo Clinic between 1986 and 1990.
All patients had received an initial fluid bolus (about 20 mL/kg) of 0.9% saline or Ringer's lactate (or both), followed by rehydration with solutions that contained 75 mmol/L of sodium at rates of approximately 3,000 mL/m2 per day. Mean corrected and uncorrected serum sodium concentrations and effective serum osmolality (before and after administration of the fluid bolus and at 6 and 12 hours into treatment) were compared by use of the paired Student t test.
After 12 hours of therapy, we found a significant increase in the mean uncorrected serum sodium level from 135.1 +/- 0.9 mmol/L to 138.1 +/- 0.7 mmol/L (P < 0.05), whereas the mean corrected serum sodium value declined slightly from 143.1 +/- 1.1 mmol/L to 140.4 +/- 0.7 mmol/L (statistically not significant). Serum osmolality based on uncorrected serum sodium concentrations decreased at a rate of 2.6 mmol/kg per hour during the first 6 hours of treatment and remained stable thereafter.
In 18 episodes of DKA in young patients, rehydration with fluids that contained 75 mmol/L of sodium at rates of approximately 3,000 mL/m2 per day after administration of a fluid bolus of 0.9% saline or Ringer's lactate (or both) was not associated with a decline in the uncorrected serum sodium concentration.
评估使用含75 mmol/L钠的溶液对糖尿病酮症酸中毒（DKA）年轻患者进行补液是否会导致血清钠浓度下降。
我们回顾性研究了1986年至1990年间在梅奥诊所接受检查的17例18岁以下患者的18次中度至重度DKA发作（平均血浆碳酸氢盐浓度为7.8±0.9 mmol/L）。
所有患者均接受了初始液体推注（约20 mL/kg）的0.9%生理盐水或乳酸林格氏液（或两者），随后以每天约3000 mL/m²的速率用含75 mmol/L钠的溶液进行补液。使用配对学生t检验比较平均校正和未校正血清钠浓度以及有效血清渗透压（在给予液体推注之前和之后以及治疗6小时和12小时时）。
治疗12小时后，我们发现平均未校正血清钠水平从135.1±0.9 mmol/L显著增加至138.1±0.7 mmol/L（P<0.05），而平均校正血清钠值从143.1±1.1 mmol/L略有下降至140.4±0.7 mmol/L（无统计学意义）。基于未校正血清钠浓度的血清渗透压在治疗的前6小时以每小时2.6 mmol/kg的速率下降，此后保持稳定。
在年轻患者的18次DKA发作中，在给予0.9%生理盐水或乳酸林格氏液（或两者）的液体推注后，以每天约3000 mL/m²的速率用含75 mmol/L钠的溶液进行补液与未校正血清钠浓度的下降无关。
