Plasma-Lyte 148 vs 0.9% Saline for Fluid Resuscitation in Diabetic Ketoacidosis

Chua, Horng-Ruey; Venkatesh, Balasubramanian; Stachowski, Edward; Schneider, Antoine; Perkins, Kelly; Ladanyi, Suzy; Krüger, Peter; Bellomo, Rinaldo

doi:10.1097/01.sa.0000428771.48543.af

Cited by 91 publications

(31 citation statements)

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“…These findings are similar to the study done by Chua et al (2012) and Mahler et al (2011). Plasmalyte was used as the balanced fluid which caused less hyperchloremic acidosis compared to normal saline.…”

Section: Discussionsupporting

confidence: 80%

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Comparing Sterofundin to 0.9% Sodium Chloride Infusion in Managing Diabetic Ketoacidosis: A Pilot Study

Muhamad¹

2017

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ABSTRAK Penggantian cecair adalah rawatan utama untuk kencing manis ketoacidosis (DKA). Pada masa ini pilihan terbaik daripada cecair masih diperdebatkan. 0.9% Normal Saline (NS) yang menyebabkan ketidakseimbangan metabolik dan asidosis metabolik biasanya digunakan. Sterofundin® merupakan kristaloid & Health Dec 2017;12(2): 179-192 Rossman H. et al. (Malaysian Clinical Practice Guidelines 2015). The ideal fluid for managing diabetic ketoacidosis (DKA) is controversial. Following substantial fluid loss due to osmotic diuresis, fluid deficit can be estimated up to 100 ml/ kg which is corrected within 24 hrs. Crystalloid 0.9% normal saline (NS) is currently the mainstay therapy for fluid replacement. Fluid replacement regiment for a systolic BP > 90 mmHg is 1000 mL of NS for the 1 st hr, another 1000 mL of NS for next 2 hrs and 1000 Kata kunci: jurang anion, diabetic ketoacidoses, keton, ph , saline, sterofundin ABSTRACTFluid replacement is the mainstay treatment for diabetic ketoacidosis (DKA). Currently, the best choice of fluids is still debatable. An amount of 0.9% sodium chloride is commonly used. Sterofundin® is an alternative crystalloid that is assumed to expedite resolution of acidosis. Advantages in sterofundin content being smaller significant ion difference (SID) to plasma and lower chloride content. The main objective of the study was to compare rate of acidosis resolution in DKA patients between treatment with 0.9% normal saline and Sterofundin over 12 hrs. Other objectives were to compare significant ion difference (SID), 12-hr blood ketone clearance and electrolyte balance between the two groups. The study was a prospective open labelled randomized control trial. This study was conducted over 6 months. Sample size of 18 was obtained with 9 for each arm. Main difference between two groups was initial median 2-hr pH level improvement (NS = +0.006 vs. Sterofundin = +0.05, P=0.063), however not being significant. Ketone, anion gap reduction, bicarbonate normalisation, sodium, chloride, urea and creatinine levels failed to show any significant differences between both groups. Twelve-hour median chloride levels increments were higher in the NS group (+11) compared to the sterofundin group (+6). There was no difference between mortality and morbidity. Comparing the two fluid groups, there was no significant biochemical differences during treatment of DKA. This was a pilot study that can initiate further clinical trials.

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Section: Discussionsupporting

confidence: 80%

“…Both group increased the bicarbonate and reduces of anion gap and significant ion difference over time. This was similar to the study on plasmalyte by Chua et al (2012) in which the balanced solution resulted in rapid acidosis resolution and lower chloride levels.…”

Section: Discussionsupporting

confidence: 66%

Comparing Sterofundin to 0.9% Sodium Chloride Infusion in Managing Diabetic Ketoacidosis: A Pilot Study

Muhamad¹

2017

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“…However, 0.9% saline is nonphysiologic and the high (chloride) and a lower strong ion difference compared to plasma (0.9% saline: 0 mmol/L vs plasma: 40 mmol/L), directly contributes to iatrogenic hyperchloremic metabolic acidosis. Indeed, the use of balanced crystalloid resuscitation in patients with diabetic ketoacidosis, despite the added (potassium) content [(K + ) 5.0 mmol/L], was associated with more rapid correction of base deficit when compared to 0.9% saline [49] . Recent data have also clearly shown high (chloride) solutions contribute to renal vasoconstriction, decreased glomerular filtration, greater interstitial fluid accumulation [29][30][31][32][33][34] along with increased risk of acute kidney injury (AKI) and utilization of renal replacement therapy (RRT) [35] .…”

Section: Type Of Fluid Therapymentioning

confidence: 99%

Controversies in fluid therapy: Type, dose and toxicity

McDermid

Raghunathan

Romanovsky

et al. 2014

WJCCM

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Fluid therapy is perhaps the most common intervention received by acutely ill hospitalized patients; however, a number of critical questions on the efficacy and safety of the type and dose remain. In this review, recent insights derived from randomized trials in terms of fluid type, dose and toxicity are discussed. We contend that the prescription of fluid therapy is context-specific and that any fluid can be harmful if administered inappropriately. When contrasting ''crystalloid vs colloid'', differences in efficacy are modest but differences in safety are significant. Differences in chloride load and strong ion difference across solutions appear to be clinically important. Phases of fluid therapy in acutely ill patients are recognized, including acute resuscitation, maintaining homeostasis, and recovery phases. Quantitative toxicity (fluid overload) is associated with adverse outcomes and can be mitigated when fluid therapy based on functional hemodynamic parameters that predict volume responsiveness and minimization of non-essential fluid. Qualitative toxicity (fluid type), in particular for iatrogenic acute kidney injury and metabolic acidosis, remain a concern for synthetic colloids and isotonic saline, respectively. Physiologically balanced crystalloids may be the ''default'' fluid for acutely ill patients and the role for colloids, in particular hydroxyethyl starch, is increasingly unclear. We contend the prescription of fluid therapy is analogous to the prescription of any drug used in critically ill patients.© 2014 Baishideng Publishing Group Co., Limited. All rights reserved.Key words: Fluid therapy; Resuscitation; Critical illness; Peri-operative; Toxicity; Saline; Crystalloid; Colloid Core tip: Fluid therapy is exceedingly common in acutely ill patients; however, numerous questions on the efficacy and safety of fluid therapy in terms of the type and dose remain. Fluid therapy prescription is contextspecific and any fluid type can be harmful if administered inappropriately. When considering crystalloids versus colloids, differences in efficacy are modest but the risk of kidney toxicity and bleeding complications with hydroxyethyl starch appear more significant. The differences in chloride load across crystalloid solutions appears to have physiologic and clinically important effects, in particular for contributing to hyperchloremic metabolic acidosis, kidney injury and greater utilization of renal replacement therapy associated with 0.9% saline. Fluid therapy should be viewed as analogous to the prescription of any drug in acutely ill patients.McDermid RC, Raghunathan K, Romanovsky A, Shaw AD, Bagshaw SM. Controversies in fluid therapy: Type, dose and toxicity.

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“…1,39,[108][109][110][111] Other references were excluded because too specific and non-functional for our purpose. We analyzed three guidelines that deal with particular aspects of septic patients, such as pregnancy, neutropenic sepsis in cancer patients and infections of the urinary tract.…”

Section: Resultsmentioning

confidence: 99%

“…[102][103][104] Some authors suggest that dilutionalhyperchloremic acidosis is related to large volumes of saline administration and the effect remains moderate and relatively transient. 105 Although there is still no answer to the best choice for volume resuscitation in sepsis, 106 recent data 102,[107][108][109] suggest that isotonic balanced solutions could be the preferred resuscitation fluids for the majority of acutely ill patients and saline could be considered in patients with hypovolemia and alkalosis. 95 By the way, the new GIFTAHo NICE guidelines recommend the measure of serum chloride anytime a solution containing chloride more than 120 mmol/L is used.…”

Section: Septic Shock: Pathophysiology and Hemodynamic Resuscitationmentioning

confidence: 99%

Management of sepsis: from evidence to clinical practice

et al. 2016

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Sepsis is one of the leading causes of death in hospitalized patients and its management involves a lot of specialist. Internist is required to demonstrate his competence since the beginning when the diagnosis is not so easy to be clarified. A rapid clinical suspicion permits a prompt management of the patient that means important mortality reduction. However, it is essential to understand the source of infection and echography represents a rapid, economic, useful and widespread tool with whom Internist should become more and more confident. The following review is a practical guide to manage septic patients according to the most recent literature, underlining aspects of antibiotic therapy, hemodynamic stabilization and supportive therapy. To limit sepsis mortality, a valid Internist should be culturally prepared and especially able to cooperate with other specialists, because a strong enemy requires a strong team.

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Plasma-Lyte 148 vs 0.9% Saline for Fluid Resuscitation in Diabetic Ketoacidosis

Cited by 91 publications

References 0 publications

Comparing Sterofundin to 0.9% Sodium Chloride Infusion in Managing Diabetic Ketoacidosis: A Pilot Study

Comparing Sterofundin to 0.9% Sodium Chloride Infusion in Managing Diabetic Ketoacidosis: A Pilot Study

Controversies in fluid therapy: Type, dose and toxicity

Management of sepsis: from evidence to clinical practice

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