Clinical Effects of Balanced Crystalloids vs Saline in Adults With Diabetic Ketoacidosis: A Subgroup Analysis of Cluster Randomized Clinical Trials.

JAMA Network Open
Wesley H SelfPragmatic Critical Care Research Group

Abstract

Saline (0.9% sodium chloride), the fluid most commonly used to treat diabetic ketoacidosis (DKA), can cause hyperchloremic metabolic acidosis. Balanced crystalloids, an alternative class of fluids for volume expansion, do not cause acidosis and, therefore, may lead to faster resolution of DKA than saline. To compare the clinical effects of balanced crystalloids with the clinical effects of saline for the acute treatment of adults with DKA. This study was a subgroup analysis of adults with DKA in 2 previously reported companion trials-Saline Against Lactated Ringer's or Plasma-Lyte in the Emergency Department (SALT-ED) and the Isotonic Solutions and Major Adverse Renal Events Trial (SMART). These trials, conducted between January 2016 and March 2017 in an academic medical center in the US, were pragmatic, multiple-crossover, cluster, randomized clinical trials comparing balanced crystalloids vs saline in emergency department (ED) and intensive care unit (ICU) patients. This study included adults who presented to the ED with DKA, defined as a clinical diagnosis of DKA, plasma glucose greater than 250 mg/dL, plasma bicarbonate less than or equal to 18 mmol/L, and anion gap greater than 10 mmol/L. Data analysis was performed from J...Continue Reading

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Citations

Feb 21, 2021·Journal of Critical Care·Michael L Moritz, Juan C Ayus
Feb 25, 2021·The American Journal of Emergency Medicine·Brit LongMichael Gottlieb
May 4, 2021·Current Opinion in Anaesthesiology·Claudia Fernandez-RoblesAdriana D Oprea
Jul 15, 2021·The Journal of Emergency Medicine·Brit LongMichael Gottlieb
Aug 6, 2021·American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists·Brian L Erstad
Oct 6, 2021·Intensive Care Medicine·Bruno Adler Maccagnan Pinheiro BesenPatrick M Honore

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