Boletín médico del Hospital Infantil de México
versión impresa ISSN 1665-1146
GOMEZ RIVERA, Norberto et al. Tratamiento hidroelectrolítico y ácido base en pacientes con cetoacidosis diabética: comparación de dos guías terapéuticas. Bol. Med. Hosp. Infant. Mex. [online]. 2004, vol.61, n.1, pp. 35-43. ISSN 1665-1146.
Introduction. The aim of this work was to compare 2 different therapeutic guidelines which recommend diverse amounts of fluids, and bicarbonate to correct dehydration and acid-base unbalance in children with diabetic ketoacidosis (DKA). Material and methods. A group (A) of patients (n= 16) with DKA treated with a guideline which recommend the reposition of basal plus negligible fluid loss without bicarbonate were compared with a second group (n =16) of DKA patients (group B) managed with another guideline which do not consider negligible fluid loss but recommend the use of bicarbonate. Patients with severe dehydratation, hyperglycemia > 300 mg/dL, pH > 7.3 or bicarbonate < 15 mmol/L, ketonemia, glycosuria, and ketonuria, were included. A bivariate test for each dependent variable, Z distribution, and Student's t test were used in the statistical analysis. Results. Correction of dehydration in a 24 h period was achieved in 81.2% of patients in group A and in 37.5% of group B (P =0.0005). Average fluid volume was 5 287 ± 1 659 mL in group B, and 8 360 ± 7 391 mL in group A. Glycemia was 292 ± 45 mg in group A, and 310 ± 76.4 mg in group B; pH was 7.32 ± 0.064 in group A, and 7.2 ± 0.146 in group B (P =0.005). After 24 h anion gap was 12.7 ± 1.57 in group A, and 29 ± 11.44 in group B (P =0.0001), serum Na was 133.9 ± 2.56 mEq/L in group A, and 147.8 ± 12.47 mEq/L in group B (P =0.001); serum K was 4.85 ± 1.15 mEq/L in group A, and 4.2 ± 0.52 mEq/L in group B (P =0.05). Osmolarity was 296 ± 6.75 mOsmol/L in group A, and 276 ± 8.08 in group B (P =0.0003). Conclusions. Stabilization after 24 h, rehydration, electrolyte and acid-base balance were more effectively achieved with the reposition of basal plus negligible losses of fluids without bicarbonate.
Palabras llave : Diabetic ketoacidosis; hydroelectrolytes; acid-base unbalance.