Resuscitation with balanced electrolyte solution prevents hyperchloremic metabolic acidosis in patients with diabetic ketoacidosis

• Published in: The American journal of emergency medicine Vol. 29; no. 6; pp. 670 - 674
• Main Authors: Mahler, Simon A., MD, Conrad, Steven A., MD, PhD, Wang, Hao, MD, PhD, Arnold, Thomas C., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.07.2011; Elsevier; Elsevier Limited
• Subjects: Acid-Base Equilibrium; Adolescent; Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Bicarbonates - administration & dosage; Bicarbonates - blood; Biological and medical sciences; Confidence intervals; Diabetes; Diabetic Ketoacidosis - prevention & control; Double-Blind Method; Electrolytes - administration & dosage; Emergency; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Emergency medical care; Female; Health sciences; Heart attacks; Humans; Insulin resistance; Intensive care medicine; Male; Medical sciences; Middle Aged; Mortality; Pediatrics; Prospective Studies; Sodium Chloride - administration & dosage; Sodium Chloride - blood; Solutions; Statistical analysis; Treatment Outcome; Water-Electrolyte Imbalance - etiology; Water-Electrolyte Imbalance - prevention & control; Endocrinopathy; Human; Metabolic disorder; Intensive care; Electrolyte solution; Ketoacidosis; Diabetes mellitus; Acid base balance disorder; Metabolic acidosis; Resuscitation
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2010.02.004

Abstract Objective The objective of the study was to determine if balanced electrolyte solution (BES) prevents hyperchloremic metabolic acidosis in patients with diabetic ketoacidosis (DKA). Methods This is a prospective, randomized, double-blind study. A convenience sample of DKA patients aged 18 to 65 years with serum bicarbonate less than or equal to 15 and anion gap greater than or equal to 16 was enrolled at “Louisiana State University Health Sciences Center-Shreveport" an capitalize Emergency Department over a 24-month period (2006-2008). Patients were randomized to standardized resuscitation with normal saline (NS) or BES (Plasma-Lyte A pH 7.4; Baxter International, Deerfield, IL). Every 2 hours, serum chloride and bicarbonate were measured until the patient's anion gap decreased to 12. An intention-to-treat analysis was performed on patients who met inclusion criteria and received at least 4 hours of study fluid. Chloride and bicarbonate measurements from the BES and NS groups were compared using unpaired and paired Student t tests. Results Of 52 patients enrolled, 45 (22 in BES group and 23 in NS group) met inclusion criteria and received 4 hours of fluid. The mean postresuscitation chloride was 111 mmol/L (95% confidence interval [CI] = 110-112) in the NS group and 105 mmol/L (95% CI = 103-108) in the BES group ( P ≤ .001). The mean postresuscitation bicarbonate was 17 mmol/L (95% CI = 15-18) in the NS group and 20 mmol/L (95% CI = 18-21) in the BES group ( P = .020). Conclusions Resuscitation of DKA patients with BES results in lower serum chloride and higher bicarbonate levels than patients receiving NS, consistent with prevention of hyperchloremic metabolic acidosis.