Lactated Ringer's versus normal saline in the management of acute diabetic ketoacidosis (RINSE-DKA).

IF 2.9 3区 医学 Q2 PHARMACOLOGY & PHARMACY
Pharmacotherapy Pub Date : 2024-08-01 Epub Date: 2024-07-30 DOI:10.1002/phar.4600
Auriene Jamison, Adham Mohamed, Courtney Chedester, Kyle Klindworth, Majdi Hamarshi, Erik Sembroski
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引用次数: 0

Abstract

Introduction: 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.

Objective: The purpose of this study was to compare lactated Ringer's (LR) to normal saline (NS) in the acute management of DKA.

Methods: 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.

Results: 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.

Conclusion: 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.

乳酸林格液与生理盐水在急性糖尿病酮症酸中毒(RINSE-DKA)治疗中的对比。
导言:糖尿病酮症酸中毒(DKA)急性期治疗的主要方法是液体复苏。美国糖尿病协会推荐使用生理盐水,但生理盐水与高胆红素代谢性酸中毒和急性肾损伤有关。在确定治疗 DKA 患者最合适的晶体液方面,现有文献资料有限:本研究旨在比较乳酸林格液(LR)和生理盐水(NS)在急性 DKA 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。方法:这是一项回顾性多中心单一医疗系统队列研究。主要结果是评估使用 LR 和 NS 治疗高阴离子间隙代谢性酸中毒(HAGMA)的时间。次要结果包括非阴离子间隙性代谢性酸中毒、高胆碱血症、急性肾损伤和新的肾脏替代治疗的发生率。其他次要结果包括胰岛素输注持续时间、住院时间和重症监护室住院时间。主要结果采用 Cox 比例危险模型:结果:共纳入 771 例患者。与 NS 相比,乳酸林格液与更快的 HAGMA 缓解时间相关(调整后的危险比为 1.325;95% 置信区间为 1.121-1.566;P 结论:乳酸林格液与更快的 HAGMA 缓解时间相关:使用 LR 作为急性 DKA 治疗的主要晶体液与 NS 相比,HAGMA 的缓解时间更短。两组患者的并发症发生率和住院时间相似。这项研究的结果补充了不断积累的文献,表明在治疗 DKA 患者时,平衡晶体液可能比 NS 更有优势。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Pharmacotherapy
Pharmacotherapy 医学-药学
CiteScore
7.80
自引率
2.40%
发文量
93
审稿时长
4-8 weeks
期刊介绍: Pharmacotherapy is devoted to publication of original research articles on all aspects of human pharmacology and review articles on drugs and drug therapy. The Editors and Editorial Board invite original research reports on pharmacokinetic, bioavailability, and drug interaction studies, clinical trials, investigations of specific pharmacological properties of drugs, and related topics.
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