Potassium chloride 600mg / Potassium bicarbonate 400mg (total potassium 12mmol) effervescent tablets sugar free

ObjectiveTo systematically synthesize evidence from RCTs that evaluate the efficacy and safety of balanced crystalloids compared with normal saline for initial fluid resuscitation of patients with DKA.MethodsThis systematic review and meta-analysis were performed considering PRISMA guidelines and was registered in PROSPERO. A comprehensive search was performed to identify RCTs comparing balanced crystalloids with normal saline in adults and children with DKA. The risk of bias was assessed by using Cochrane RoB 2 tool. A random-effects meta-analysis was performed using R software to calculate pooled Mean Differences for continuous outcomes and Odds Ratios for dichotomous outcomes with 95% Confidence Intervals.ResultsEleven RCTs were included. In the quantitative synthesis of six RCTs (n = 491) using continuous time-to-event data, balanced crystalloids were not associated with a statistically significant reduction in time to DKA resolution compared with normal saline (Mean Difference [MD] = -1.50 hours; 95% CI: -3.79 to 0.79; p=0.15), with moderate heterogeneity (I2 = 36.2%). The 95% prediction interval ranged from -5.44 to 2.44 hours. However, balanced crystalloids resulted in a significantly greater increase in serum bicarbonate at 12 hours (MD = +2.50 mmol/L; 95% CI: 1.51 to 3.48; p=0.004; I2 = 0.0%). Subgroup analyses by fluid type, DKA severity, and age group showed no significant subgroup differences.ConclusionInitial fluid resuscitation with balanced crystalloids was not associated with a shorter time to DKA resolution compared with normal saline, and they were associated with a rapid increase in serum bicarbonate levels; however, this biochemical improvement did not translate into a shorter time to DKA resolution or other clinical benefits. The choice of crystalloids for initial DKA resuscitation remains an area of clinical equipoise because of the substantial heterogeneity and methodological limitations of the available evidence, emphasizing the need for further high-quality research.

Abstract licence: CC BY

BackgroundAdministration of intravenous fluids prior to competition is common at major equestrian competitions, yet few studies have evaluated the benefits of this practice.Aims/objectiveThe hypothesis was that pre-ride intravenous fluid therapy would be associated with a lower heart rate and improved laboratory hydration parameters during or after the ride.Methods14 client owned horses entered in a 45 km ride in extreme heat and terrain were randomly assigned to receive IV fluids (IVF) or no IV fluids (NIV) the day before the ride. Blood samples and physical examination findings were collected at 6 time points: Home (T0), check in the day before the ride (T1), 2-3 h after catheterization and treatment (T2), 1 h pre-ride (T3), 32 km into the ride (T4), and the end of the ride (T5). Physical examination and laboratory parameters (bicarbonate, sodium, potassium, chloride, calcium, glucose, lactate, BUN, creatinine, PCV and total protein) were evaluated using 2-way ANOVA.ResultsThe total protein concentration at T2 was 0.5 g/dL lower in the IVF group (95 % CI, -1.0 to -0.01 g/dL) compared with the NIV. The BUN concentration at T4 was 4 mg/dL lower in the IVF group (p = 0.02; 95 % CI, -7.3 to -0.9 mg/dL) compared with the NIV. There was no significant difference in heart rates between the IVF and NIV group (36 ± 5 bpm and 39 ± 3 bpm, respectively; p = 0.23).ConclusionsThe use of intravenous fluids prior to riding in extreme conditions may not have clinically significant hydration benefits.

Abstract licence: CC BY-NC-ND