Normal Saline Versus Ringer’s Lactate for Intravenous Fluid Therapy in Children with Diabetic Ketoacidosis: A Randomized Controlled Trial

To compare normal saline (NS) and ringer’s lactate (RL) as intravenous fluid therapy in children with diabetic ketoacidosis (DKA).

This was a triple blinded randomized controlled trial conducted in the Pediatric Intensive Care Unit (PICU) of a tertiary care hospital in New Delhi from November 2018 to March 2020. The study compared intravenous fluid therapy with ringer’s lactate and normal saline in children aged 6 mo to 18 y with DKA as defined by The International Society for Pediatric and Adolescent Diabetes (ISPAD). The primary objective was comparing the time taken to achieve resolution of acidosis (pH ≥ 7.3) in both groups. Secondary objectives included comparing the proportion of patients that develop acute kidney injury; comparing the time taken for normalization of anion gap and blood glucose; time taken to change the type of fluid; total amount of fluid and insulin administered; and total length of PICU and hospital stay.

Fifty patients were enrolled, with 25 in each arm and all but one achieved the primary outcome. The median age of the patients was 9 (5, 12) y. The time taken for resolution of acidosis in patients treated with NS was 12 (4, 18) h and with RL was 8 (4, 10) h (p = 0.16). The NS group had a significantly higher incidence of hyperchloremia (p < 0.05) and longer PICU stay (p < 0.05). The metabolic profile and incidence of complications were comparable in both groups.

Ringer’s lactate can safely be considered for the management of pediatric DKA and may be preferred in patients that are at a risk of complications due to hyperchloremia.