Fluid management in diabetic-acidosis — Ringer’s lactate versus normal saline : a randomized controlled trial

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dc.contributor.author Van Zyl, Danie G.
dc.contributor.author Rheeder, Paul
dc.contributor.author Delport, Eluned F.
dc.date.accessioned 2012-06-19T07:13:36Z
dc.date.available 2012-06-19T07:13:36Z
dc.date.issued 2012-04
dc.description.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. en_US
dc.description.sponsorship University of Pretoria, Research Development Programme en_US
dc.description.uri http://qjmed.oxfordjournals.org/ en_US
dc.identifier.citation Van Zyl, DG, Rheeder, P & Delport, E 2011, 'Fluid management in diabetic-acidosis — Ringer’s lactate versus normal saline : a randomized controlled trial', QJM-An International Journal of Medicine, vol. 105, no. 4, pp. 337-343. en_US
dc.identifier.issn 1460-2725 (print)
dc.identifier.issn 1460-2393 (online)
dc.identifier.other 10.1093/qjmed/hcr226
dc.identifier.uri http://hdl.handle.net/2263/19208
dc.language.iso en en_US
dc.publisher Advance Access en_US
dc.rights © The Author 2011. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. en_US
dc.subject Ringer’s lactate en_US
dc.subject Diabetic ketoacidosis (DKA) en_US
dc.subject Fluid management en_US
dc.subject Normal saline en_US
dc.subject.lcsh Diabetes -- Treatment en
dc.title Fluid management in diabetic-acidosis — Ringer’s lactate versus normal saline : a randomized controlled trial en_US
dc.type Postprint Article en_US


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