title: Controlled trial of Hartmann's solution versus 0.9% saline for diabetic ketoacidosis.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Paediatric Critical Care, Women's and Children's Hospital, Adelaide, South Australia, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Yung
authors.affiliation: Department of Paediatric Critical Care, Women's and Children's Hospital, Adelaide, South Australia, Australia.
authors.forename: Georgia
authors.initials: G
authors.lastname: Letton
authors.affiliation: Department of Paediatric Critical Care, Women's and Children's Hospital, Adelaide, South Australia, Australia.
authors.forename: Steve
authors.initials: S
authors.lastname: Keeley
mesh_terms: D000293:Adolescent; D002648:Child; D016883:Diabetic Ketoacidosis / Q000188:drug therapy* / Q000517:prevention & control*; D004311:Double-Blind Method; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D008297:Male; D012965:Sodium Chloride / Q000008:administration & dosage* / Q000627:therapeutic use*
chemical_list: D012965:Sodium Chloride
keywords: diabetic ketoacidosis; intravenous infusion; metabolic acidosis