Fluid resuscitation with balanced electrolyte solutions results in faster resolution of diabetic ketoacidosis than with 0.9% saline in adults - A systematic review and meta-analysis.

التفاصيل البيبلوغرافية
العنوان:	Fluid resuscitation with balanced electrolyte solutions results in faster resolution of diabetic ketoacidosis than with 0.9% saline in adults - A systematic review and meta-analysis.
المؤلفون:	Szabó GV; Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.; Emergency Department, Szent György University Teaching Hospital of Fejér County, Székesfehérvár, Hungary.; National Ambulance Service, Budapest, Hungary.; Hungarian Air Ambulance Nonprofit Ltd., Budaörs, Hungary., Szigetváry C; Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.; Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary., Turan C; Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.; Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary., Engh MA; Centre for Translational Medicine, Semmelweis University, Budapest, Hungary., Terebessy T; Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.; Department of Orthopaedics, Semmelweis University, Budapest, Hungary., Fazekas A; Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary., Farkas N; Institute of Bioanalysis, Medical School, University of Pécs, Pécs, Hungary., Hegyi P; Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.; Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary., Molnár Z; Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.; Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary.; Department of Anesthesiology and Intensive Therapy, Poznan University, Poznan, Poland.
المصدر:	Diabetes/metabolism research and reviews [Diabetes Metab Res Rev] 2024 Jul; Vol. 40 (5), pp. e3831.
نوع المنشور:	Journal Article; Meta-Analysis; Systematic Review
اللغة:	English
بيانات الدورية:	Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 100883450 Publication Model: Print Cited Medium: Internet ISSN: 1520-7560 (Electronic) Linking ISSN: 15207552 NLM ISO Abbreviation: Diabetes Metab Res Rev Subsets: MEDLINE
أسماء مطبوعة:	Original Publication: Oxford, England : Wiley-Blackwell, c1999-
مواضيع طبية MeSH:	Diabetic Ketoacidosis/therapy , Diabetic Ketoacidosis/drug therapy , Fluid Therapy/methods , Saline Solution/administration & dosage, Adult ; Humans ; Electrolytes/administration & dosage ; Prognosis ; Resuscitation/methods
مستخلص:	Fluid resuscitation during diabetic ketoacidosis (DKA) is most frequently performed with 0.9% saline despite its high chloride and sodium concentration. Balanced Electrolyte Solutions (BES) may prove a more physiological alternative, but convincing evidence is missing. We aimed to compare the efficacy of 0.9% saline to BES in DKA management. MEDLINE, Cochrane Library, and Embase databases were searched for relevant studies using predefined keywords (from inception to 27 November 2021). Relevant studies were those in which 0.9% saline (Saline-group) was compared to BES (BES-group) in adults admitted with DKA. Two reviewers independently extracted data and assessed the risk of bias. The primary outcome was time to DKA resolution (defined by each study individually), while the main secondary outcomes were changes in laboratory values, duration of insulin infusion, and mortality. We included seven randomized controlled trials and three observational studies with 1006 participants. The primary outcome was reported for 316 patients, and we found that BES resolves DKA faster than 0.9% saline with a mean difference (MD) of -5.36 [95% CI: -10.46, -0.26] hours. Post-resuscitation chloride (MD: -4.26 [-6.97, -1.54] mmoL/L) and sodium (MD: -1.38 [-2.14, -0.62] mmoL/L) levels were significantly lower. In contrast, levels of post-resuscitation bicarbonate (MD: 1.82 [0.75, 2.89] mmoL/L) were significantly elevated in the BES-group compared to the Saline-group. There was no statistically significant difference between the groups regarding the duration of parenteral insulin administration (MD: 0.16 [-3.03, 3.35] hours) or mortality (OR: -0.67 [0.12, 3.68]). Studies showed some concern or a high risk of bias, and the level of evidence for most outcomes was low. This meta-analysis indicates that the use of BES resolves DKA faster than 0.9% saline. Therefore, DKA guidelines should consider BES instead of 0.9% saline as the first choice during fluid resuscitation. (© 2024 The Author(s). Diabetes/Metabolism Research and Reviews published by John Wiley & Sons Ltd.)
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فهرسة مساهمة:	Keywords: 0.9% saline; balanced electrolyte solutions; diabetes mellitus; diabetic ketoacidosis; time to diabetic ketoacidosis resolution
المشرفين على المادة:	0 (Electrolytes) 0 (Saline Solution)
تواريخ الأحداث:	Date Created: 20240626 Date Completed: 20240626 Latest Revision: 20240628
رمز التحديث:	20240628
DOI:	10.1002/dmrr.3831
PMID:	38925619
قاعدة البيانات:	MEDLINE

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تدمد:	1520-7560
DOI:	10.1002/dmrr.3831