0.9% Saline versus Ringer's lactate as initial fluid in children with diabetic ketoacidosis: a double-blind randomized controlled trial.

IF 3.7 2区医学 Q2 ENDOCRINOLOGY & METABOLISM

BMJ Open Diabetes Research & Care Pub Date : 2025-04-07 DOI:10.1136/bmjdrc-2024-004623

Ashish Agarwal, Muralidharan Jayashree, Karthi Nallasamy, Devi Dayal, Savita Verma Attri

{"title":"0.9% Saline versus Ringer's lactate as initial fluid in children with diabetic ketoacidosis: a double-blind randomized controlled trial.","authors":"Ashish Agarwal, Muralidharan Jayashree, Karthi Nallasamy, Devi Dayal, Savita Verma Attri","doi":"10.1136/bmjdrc-2024-004623","DOIUrl":null,"url":null,"abstract":"Introduction: Ringer's lactate (RL), a balanced crystalloid by regenerating bicarbonate ion, may lead to early diabetic ketoacidosis (DKA) resolution and reduced hyperchloremia as compared with 0.9% saline (NS).Research design and methods: This was a double-blind randomized controlled trial conducted in the pediatric emergency and intensive care units of a teaching hospital. Children with type 1 diabetes mellitus (T1DM) aged 9 months to 12 years who presented in DKA were included. Participants were randomized to receive either NS or RL as initial fluid (used for both resuscitation and replacement). The primary outcome was time to resolution of DKA. Secondary outcomes included change in serum chloride and bicarbonate from baseline, total fluid received and incidence of acute kidney injury.Results: The study was conducted between December 2020 and December 2021, and 67 children were recruited (34 in the NS group and 33 in the RL group). The mean time to DKA resolution was shorter in the RL group compared with the NS group (12.9±7.9 vs 16.8±9 hours). The mean difference and HR for time to DKA resolution in the RL group compared with the NS group were 3.85 hours (95% CI 0.3 to 8) and 1.39 hours (95% CI 1.25 to 1.56), respectively. The rise in chloride from baseline was higher in the NS group as compared with the RL group at 4 and 8 hours (8.7±5.6 vs 3.9±5.1 mmol/L) and (10.8±7.7 vs 4.4±8.3 mmol/L), respectively. On the contrary, the rise in bicarbonate from baseline to 12 hours was significantly higher in the RL group as compared with the NS group (14.7±1.6 vs 12.9±3.1).Conclusions: The time to resolution of DKA was shorter in RL group as compared with the NS group. Regeneration of bicarbonate from lactate ion in the RL forms a strong physiological basis for this outcome as compared with hyperchloremia induced by NS. This makes RL a favorable option in children with DKA.","PeriodicalId":9151,"journal":{"name":"BMJ Open Diabetes Research & Care","volume":"13 2","pages":""},"PeriodicalIF":3.7000,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMJ Open Diabetes Research & Care","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/bmjdrc-2024-004623","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction: Ringer's lactate (RL), a balanced crystalloid by regenerating bicarbonate ion, may lead to early diabetic ketoacidosis (DKA) resolution and reduced hyperchloremia as compared with 0.9% saline (NS).

Research design and methods: This was a double-blind randomized controlled trial conducted in the pediatric emergency and intensive care units of a teaching hospital. Children with type 1 diabetes mellitus (T1DM) aged 9 months to 12 years who presented in DKA were included. Participants were randomized to receive either NS or RL as initial fluid (used for both resuscitation and replacement). The primary outcome was time to resolution of DKA. Secondary outcomes included change in serum chloride and bicarbonate from baseline, total fluid received and incidence of acute kidney injury.

Results: The study was conducted between December 2020 and December 2021, and 67 children were recruited (34 in the NS group and 33 in the RL group). The mean time to DKA resolution was shorter in the RL group compared with the NS group (12.9±7.9 vs 16.8±9 hours). The mean difference and HR for time to DKA resolution in the RL group compared with the NS group were 3.85 hours (95% CI 0.3 to 8) and 1.39 hours (95% CI 1.25 to 1.56), respectively. The rise in chloride from baseline was higher in the NS group as compared with the RL group at 4 and 8 hours (8.7±5.6 vs 3.9±5.1 mmol/L) and (10.8±7.7 vs 4.4±8.3 mmol/L), respectively. On the contrary, the rise in bicarbonate from baseline to 12 hours was significantly higher in the RL group as compared with the NS group (14.7±1.6 vs 12.9±3.1).

Conclusions: The time to resolution of DKA was shorter in RL group as compared with the NS group. Regeneration of bicarbonate from lactate ion in the RL forms a strong physiological basis for this outcome as compared with hyperchloremia induced by NS. This makes RL a favorable option in children with DKA.

查看原文本刊更多论文

0.9%生理盐水与乳酸林格液作为初始液体治疗糖尿病酮症酸中毒儿童：一项双盲随机对照试验

林格氏乳酸（RL）是一种通过再生碳酸氢盐离子而平衡的晶体，与0.9%生理盐水（NS）相比，它可能导致早期糖尿病酮症酸中毒（DKA）的缓解和高氯血症的减少。研究设计与方法：本研究是在某教学医院儿科急诊科和重症监护病房进行的双盲随机对照试验。年龄在9个月至12岁之间且表现为DKA的1型糖尿病（T1DM）儿童被纳入研究。参与者随机接受NS或RL作为初始液体（用于复苏和替代）。主要观察指标为DKA消退时间。次要结局包括血清氯化物和碳酸氢盐较基线的变化、接受的总液体量和急性肾损伤的发生率。结果：研究于2020年12月至2021年12月进行，共招募了67名儿童（NS组34名，RL组33名）。RL组到DKA消退的平均时间较NS组短（12.9±7.9 h vs 16.8±9 h）。与NS组相比，RL组到DKA解决时间的平均差异和HR分别为3.85小时（95% CI 0.3 ~ 8）和1.39小时（95% CI 1.25 ~ 1.56）。与RL组相比，NS组在4和8小时的氯化物浓度较基线升高更高（8.7±5.6 vs 3.9±5.1 mmol/L）和（10.8±7.7 vs 4.4±8.3 mmol/L）。相反，与NS组相比，RL组从基线到12小时的碳酸氢盐升高明显更高（14.7±1.6 vs 12.9±3.1）。结论：RL组DKA的消退时间较NS组短。与NS诱导的高氯血症相比，RL中乳酸离子再生碳酸氢盐形成了强有力的生理基础。这使得RL成为DKA患儿的一个有利选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

BMJ Open Diabetes Research & Care Medicine-Endocrinology, Diabetes and Metabolism

CiteScore

9.30

自引率

2.40%

发文量

123

审稿时长

18 weeks

期刊介绍： BMJ Open Diabetes Research & Care is an open access journal committed to publishing high-quality, basic and clinical research articles regarding type 1 and type 2 diabetes, and associated complications. Only original content will be accepted, and submissions are subject to rigorous peer review to ensure the publication of high-quality — and evidence-based — original research articles.