Balanced crystalloid (Sterofundin) vs. normal saline for diabetic ketoacidosis: a prospective intervention trial with historical controls.

IF 7.3 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

QJM: An International Journal of Medicine Pub Date : 2025-02-01 DOI:10.1093/qjmed/hcae169

D Bharti, S Selvam, N Sharma, P Dutta, A K Pannu

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引用次数: 0

Abstract

Background: Fluid therapy with normal saline (NS) in diabetic ketoacidosis (DKA) can cause hyperchloremic acidosis and delay DKA resolution. Balanced crystalloids may address this concern, though results with Ringer lactate and Plasma-Lyte have been mixed.

Aim: This study aimed to compare the effectiveness of Sterofundin (SF) vs. NS in the management of DKA.

Methods: A prospective, intervention trial with historical controls was conducted at the Postgraduate Institute of Medical Education and Research, Chandigarh, India. Patients aged 13 years or older with DKA were enrolled. The primary outcome was the time taken to DKA resolution, with a predefined superiority margin of a one-fourth reduction in resolution time. Secondary outcomes included total intravenous fluid and short-acting regular insulin requirements, the need for 0.45% saline, hospital stay duration and in-hospital mortality.

Results: A total of 150 patients (mean age 36.8 years, 56.7% males) were included, with 75 receiving SF (intervention group) and 75 receiving NS (historical control group). The SF group showed a significantly shorter mean time to DKA resolution (13.8 ± 6.0 h) compared to the NS group (18.1 ± 5.5 h; P < 0.001). SF patients required less total intravenous fluid (4500 vs. 6000 ml; P = 0.004), less insulin (98 units vs. 112 units; P = 0.017) and had a lower need for 0.45% saline (8% vs. 74.3%; P < 0.001). Patients receiving SF had shorter hospital stays (4 [interquartile range, IQR 3-5] days vs. 4 [IQR 4-6] days; P = 0.020). Mortality rates were similar between the groups (SF: 9.3%, NS: 8.1%; P = 0.791).

Conclusion: SF may be a superior alternative to NS for fluid therapy in DKA.

查看原文本刊更多论文

治疗糖尿病酮症酸中毒的平衡晶体液（Sterofundin）与正常生理盐水：带历史对照的前瞻性干预试验。

背景：糖尿病酮症酸中毒（DKA）患者使用生理盐水（NS）进行输液治疗会导致高胆酸血症酸中毒，并延迟 DKA 的缓解。平衡晶体液可以解决这一问题，但乳酸林格液和血浆莱特液的治疗效果不一。目的：本研究旨在比较斯特罗芬定（SF）与正常生理盐水（NS）在治疗 DKA 中的效果：方法：印度昌迪加尔研究生医学教育与研究所进行了一项前瞻性干预试验，并设历史对照。年龄在 13 岁或以上的 DKA 患者均被纳入试验范围。主要结果是DKA缓解所需的时间，预设的优越性是缓解时间缩短四分之一。次要结果包括静脉输液和短效胰岛素总需求、0.45%生理盐水需求、住院时间和院内死亡率：共纳入 150 名患者（平均年龄 36.8 岁，56.7% 为男性），其中 75 人接受 SF（干预组），75 人接受 NS（历史对照组）。与 NS 组（18.1 ± 5.5 小时；P 结论：SF 组的 DKA 缓解平均时间（13.8 ± 6.0 小时）明显短于 NS 组：在 DKA 的输液治疗中，SF 可作为 NS 的替代品。

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

QJM: An International Journal of Medicine 医学-医学：内科

CiteScore

6.90

自引率

5.30%

发文量

263

审稿时长

4-8 weeks

期刊介绍： QJM, a renowned and reputable general medical journal, has been a prominent source of knowledge in the field of internal medicine. With a steadfast commitment to advancing medical science and practice, it features a selection of rigorously reviewed articles. Released on a monthly basis, QJM encompasses a wide range of article types. These include original papers that contribute innovative research, editorials that offer expert opinions, and reviews that provide comprehensive analyses of specific topics. The journal also presents commentary papers aimed at initiating discussions on controversial subjects and allocates a dedicated section for reader correspondence. In summary, QJM's reputable standing stems from its enduring presence in the medical community, consistent publication schedule, and diverse range of content designed to inform and engage readers.