(1391) Time to Resolution of DKA With Lactated Ringer Versus Normal Saline

Introduction: Diabetic ketoacidosis (DKA) is an acute metabolic, acidotic complication of diabetes. Management consists of fluid resuscitation, correcting electrolytes, glycemic control, and determining precipitating factors. Guidelines recommend normal saline (NS) despite literature showing increased incidence of hyperchloremic metabolic acidosis. Alternative fluid options representing more physiologic chloride content, such as Lactated Ringer’s (LR), have been evaluated and showed faster resolution of DKA. The study site adopted these results, updating the DKA order set to LR for fluid resuscitation. The purpose of this study was to compare time to DKA resolution with LR vs. NS.

Methods: IRB approved, single center, retrospective, cohort evaluation. A report identified patients prescribed the DKA order set from June 1 – December 31, 2020 (NS cohort) and June 1 – December 31, 2022 (LR cohort). Criteria for inclusion consisted of admission to ICU from ED with a DKA diagnosis. Patients were excluded if they had hypokalemia on initial labs (potassium < 4 mEq/L), were diagnosed with hyperosmolar hyperglycemia, were treated for DKA in acute care areas, expired or discharged prior to DKA resolution. DKA resolution was defined as two consecutive anion gap ≤ 12. The outcome was to compare time to resolution of DKA with LR vs. NS. Student t-test was used.

Results: A total of 389 patients were screened for inclusion, with 285 patients included (138 LR cohort, 147 NS cohort). The cohorts were well balanced in regards to baseline characteristics. There was no difference in DKA severity as indicated by similar admission lab values and calculated anion gaps. The mean fluid volumes prior to ICU arrival and at resolution were similar between cohorts, although the LR cohort received almost 1 liter more at resolution (6.4 L vs. 5.5 L, p=0.966). The time to DKA resolution was 4.5 hours longer in the LR cohort (p < 0.0001).

Conclusions: LR for DKA management was associated with a longer time to resolution. This differs from current literature which found a shorter time to DKA resolution with balanced fluids (3.9 hours). The observed difference may be attributed to time between lab draws or compliance with the DKA order set. Future directions include evaluation of protocol compliance to determine the validity of these results.