Abstract:
OBJECTIVE: To determine if Ringer’s lactate is superior
to 0.9% sodium chloride solution for resolution
of acidosis in the management of diabetic ketoacidosis
(DKA).
DESIGN: Parallel double blind randomized controlled
trial.
METHODS: Patients presenting with DKA at Kalafong
and Steve Biko Academic hospitals were recruited
for inclusion in this study if they were >18 years of
age, had a venous pH >6.9 and 47.2, a blood glucose
of >13 mmol/l and had urine ketones of 52+.
All patients had to be alert enough to give informed
consent and should have received <1 l of resuscitation
fluid prior to enrolment.
RESULTS: Fifty-seven patients were randomly allocated,
29 were allocated to receive 0.9% sodium
chloride solution and 28 to receive Ringer’s lactate
(of which 27 were included in the analysis in each
group). An adjusted Cox proportional hazards analysis
was done to compare the time to normalization
of pH between the 0.9% sodium chloride solution
and Ringer’s lactate groups. The hazard ratio
(Ringer’s compared with 0.9% sodium chloride
solution) for time to venous pH normalization
(pH = 7.32) was 1.863 (95% CI 0.937–3.705,
P = 0.076). The median time to reach a pH of 7.32
for the 0.9% sodium chloride solution group was
683 min (95% CI 378–988) (IQR: 435–1095 min)
and for Ringer’s lactate solution 540 min (95% CI
184–896, P = 0.251). The unadjusted time to lower
blood glucose to 14 mmol/l was significantly longer
in the Ringer’s lactate solution group (410 min,
IQR: 240–540) than the 0.9% sodium chloride solution
group (300 min, IQR: 235–420, P = 0.044). No
difference could be demonstrated between the
Ringer’s lactate and 0.9% sodium chloride solution
groups in the time to resolution of DKA (based on
the ADA criteria) (unadjusted: P = 0.934, adjusted:
P = 0.758)
CONCLUSION: This study failed to indicate benefit
from using Ringer’s lactate solution compared to
0.9% sodium chloride solution regarding time to
normalization of pH in patients with DKA. The
time to reach a blood glucose level of 14 mmol/l
took significantly longer with the Ringer’s lactate
solution.
