Controlled trial of Hartmann's solution versus 0.9% saline for diabetic ketoacidosis

Aim We aimed to determine whether using a balanced salt solution, Hartmann's solution ( HS ), in diabetic ketoacidosis ( DKA ) shortens the time to normalise acid–base status through the avoidance of hyperchloremic metabolic acidosis compared with 0.9% normal saline ( NS ). Methods We conducted a double‐blind, randomised controlled trial comparing HS to NS as the initial intravenous fluid in children with DKA . Patients were stratified by severity ( pH  < 7.1) and known or new diabetes. Electrolytes, venous blood gases and glucose were measured every 2 h until intravenous fluids were ceased. The primary outcome was the time for the plasma bicarbonate to reach 15 mmol/L. Secondary outcomes included time to normalise pH (7.3), time to receive subcutaneous ( SC ) insulin, change in sodium and insulin requirement. Results A total of 77 children were enrolled. The groups were similar at baseline. There was no difference in the time to reach a bicarbonate of 15 mmol/L: geometric mean ( SD ) 8.6 (2.3) h for NS versus 6.2 (4.7) h for HS , ratio 1.4 (95% confidence interval 0.8–2.5), and no difference in time to normalise pH : NS 8.5 (2.3) h versus HS group 7.5 (1.8) h, ratio 1.1 (0.8–1.6). Kaplan–Meier survival estimates showed shorter times for these end‐points in the severe subgroup: log‐rank test P  = 0.0277 and 0.0024, respectively. There was no difference in time to SC insulin, NS : 15.2 (2.4) h versus HS 14.3 (1.6) h, ratio 1.1 (0.8–1.5). Patients treated with HS received significantly less total fluids/kg. Conclusions HS is an acceptable alternative to NS in DKA and may benefit those with severe DKA .