The effect of balanced electrolyte solution versus normal saline in the prevention of hyperchloremic metabolic acidosis in diabetic ketoacidosis patients: a randomized controlled trial
Abstract: In resuscitation,
normal saline could cause hyperchloremic metabolic acidosis, while balanced
electrolyte solution is a crystalloid fluid resembling blood plasma with lower
chloride content. This study compared the effect of normal saline and balanced
electrolyte solution Ringerfundin (BES) as the resuscitation fluid in diabetic
ketoacidosis (DKA) patients. Parameters applied in this study were standard
base excess (SBE) as resuscitation’s result indicator and strong ion difference
(SID) to measure chloride’s influence in developing hyperchloremic acidosis.
Methods: A prospective, randomized, single blind controlled trial was
conducted at the Emergency Department of Cipto Mangunkusumo Hospital. Thirty subjects
with blood sugar >250 mg/dl, arterial pH <7.35 mg/dl, and positive blood
ketone were randomly allocated to receive either normal saline (NS) or
RingerfundinÒ (BES) as the standardized resuscitation protocol. Data analysis
was performed using the unpaired T-test and the Mann Whitney test to compare
the SBE and the SID means between both groups. Additional parameters were the
level of consciousness, blood sugar level, vital signs, blood gas analysis,
lactate, electrolyte, and blood ketone.
Results: The mean SID in the BES group was significantly greater than the
NS group of all measurements (p<0.05). The BES group had significantly
higher mean SBE compared to the NS group at 18 hours (-4.88±5.69 vs -9.68±5.64;
p=0.009), 24 hours (-3.99±4.27 vs -8.7±5.35; p=0.023), and 48 hours (-4.06±4.11
vs -7.01±5.46; p=0.009). BES resulted in non-significant higher delta SBE and
SID than NS. Additional parameters were not different between both groups.
Conclusion: This study showed that fluid resuscitation of DKA patients
with BES resulted in slightly but not significantly higher mean actual SBE and
SID than NS. suggesting that BES as an alternative fluid resuscitation to
prevent hyperchloremic acidosis in diabetic ketoacidosis patients was not
superior to NS.
Keywords: balanced electrolyte
solution; diabetic ketoacidosis; hyperchloremic acidosis; normal saline
standard base excess; strong ion difference
Author: Dita Aditianingsih,
Anne S. Djaja, Yohanes W.H. George
Journal Code: jpkedokterangg170201
