The effect of balanced electrolyte solution versus normal saline in the prevention of hyperchloremic metabolic acidosis in diabetic ketoacidosis patients: a randomized controlled trial Keywords: balanced electrolyte solution, diabetic ketoacidosis, hyperchloremic acidosis, normal saline, standard base excess, strong ion difference (-4,88±5,69 vs -9,68±5,64; p=0,009), 24 jam (-3,99±4,27 vs -8,7± 5,35; p=0,023), dan 48 jam (-4,06±4,11 vs -7,01±5,46; p=0,009) . Selisih nilai BES dan SID tiap pengukuran dengan nilai awal jam 0 (delta BES dan delta SID) lebih tinggi pada kelompok BES, tetapi tidak signifikan. Kesimpulan: Penelitian ini menunjukkan bahwa balanced electrolyte solution (BES) sebagai cairan alternatif untuk resusitasi pasien KAD dapat mengurangi efek asidosis hiperkloremik dengan rerata aktual dan delta SID dan SBEyang lebih tinggi, tetapi tidak secara signifikan lebih superior dibandingkan dengan normal saline. ABSTRACTBackground: In resuscitation, normal saline could cause hyperchloremic metabolic acidosis, while balanced electrolyte solution is a crystalloid fluid resembling blood plasma with lower chloride content. This study compared the effect of normal saline and balanced electrolyte solution Ringerfundin (BES) as the resuscitation fluid in diabetic ketoacidosis (DKA) patients. Parameters applied in this study were standard base excess (SBE) as resuscitation's result indicator and strong ion difference (SID) to measure chloride's influence in developing hyperchloremic acidosis. Methods:A prospective, randomized, single blind controlled trial was conducted at the Emergency Department of Cipto Mangunkusumo Hospital. Thirty subjects with blood sugar >250 mg/dl, arterial pH <7.35 mg/dl, and positive blood ketone were randomly allocated to receive either normal saline (NS) or RingerfundinÒ (BES) as the standardized resuscitation protocol. Data analysis was performed using the unpaired T-test and the Mann Whitney test to compare the SBE and the SID means between both groups. Additional parameters were the level of consciousness, blood sugar level, vital signs, blood gas analysis, lactate, electrolyte, and blood ketone. Results:The mean SID in the BES group was significantly greater than the NS group of all measurements (p<0.05). The BES group had significantly higher mean SBE compared to the NS group at 18 hours (-4.88±5.69 vs -9.68±5.64; p=0.009), 24 hours (-3.99±4.27 vs -8.7±5.35; p=0.023), and 48 hours (-4.06±4.11 vs -7.01±5.46; p=0.009). BES resulted in nonsignificant higher delta SBE and SID than NS. Additional parameters were not different between both groups. Conclusion:This study showed that fluid resuscitation of DKA patients with BES resulted in slightly but not significantly higher mean actual SBE and SID than NS. suggesting that BES as an alternative fluid resuscitation to prevent hyperchloremic acidosis in diabetic ketoacidosis patients was not superior to NS.
Latar Belakang: Infus sodium bikarbonat diberikan kepada pasien asidosis dengan pH kurang dari 7,1. Asidosis mematikan / letal, yang berarti pH kurang dari 7,1, akan menonaktifkan enzim dan modulator lain dalam tubuh dan oleh karena itu harus dikoreksi.Kasus: Seorang wanita berusia 51 tahun dirawat di rumah sakit dengan keluhanutama nyeri dada atipikal sejak satu hari yang lalu. Dia memiliki riwayat diabetes mellitus tipe 2, dikontrol dengan metformine 3x500 mg, penyakit ginjal kronis dengan urin produksi 0,6 cc / kg / jam. Riwayat penurunan kesadaran, penyakit serebrovaskular, dan infark miokard disangkal. Saat masuk bangsal perawatan, ia tampak sakit parah, dengan tekanan darah 110/70 mmHg, nadi 65 kali per menit, dan frekuensi napas 32 kali per menit.Ringkasan: Hanya tiga variabel independen yang bisa merubah pH, yaitu ion-ion kuat (SID/ Strong ion Differences), pCO2, dan ATOT. Mekanisme peran natrium bikarbonat dalam meningkatkan pH adalah dengan meningkatkan tingkat SID/ Strong Ion Differences. Pemberian berlebih dari natrium bikarbonat meningkatkan tingkat pH cepat. Itu membuat oksigen tidak dapat memisahkan dari hemoglobin, menyebabkan hipoksia seluler, dan menginduksi kematian sel.
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