A Comparative Study between Ringer Lactate, Normal Saline and Plasmalyte on the Serum Electrolytes of Patients with Diabetic Ketoacidosis
Authors:   Associate professor, Dept of Medicine, Vinayaka Mission’s Kirupananda, Variyar Medical College & Hospitals (VMKVMCH), Salem – 636308 Tamil Nadu., Rajamani Shanmugasundaram , Selvarajan Karthikeyan Poongodi ,   Assistant Professor, Dept of Medicine, Vinayaka Mission’s Kirupananda, Variyar Medical College & Hospitals (VMKVMCH), Salem – 636308 Tamil Nadu., Radhakrishnan Shankar ,   Associate Professor, Dept of Preventive Medicine, Vinayaka Mission’s Kirupananda, Variyar Medical College & Hospitals (VMKVMCH), Salem – 636308 Tamil Nadu.
Published: January 2024

Background: The triad of DKA includes hyperglycaemia, ketosis, and acidemia. The management of diabetic ketoacidosis is complex and involves many aspects. It includes identification and correction of all the metabolic abnormalities and treating all the co-morbid and precipitating conditions. In DKA the most important and the initial step of management is correction of acidosis by rapid fluid replacement using a crystalloid and among them the most commonly used were 0.9% normal saline or ringer lactate. Aim: 1. To compare individually, the effects of Ringer lactate, Normal saline and plasmalyte on the serum electrolytes during the recovery period of diabetic ketoacidotic patients. 2. To determine the IV fluid most suitable for fluid resuscitation in the management of diabetic ketoacidosis. Materials and Methods: A prospective comparative study was done on 120 patients with diabetic ketoacidosis reported to our hospital over a period of one year from June 2015 –Nov 2016. The patients were divided into three groups of 40 in each group. Group A (40) were administered normal saline, Group B (40) were given ringer lactate and Group C (40) were given plasmalyte. Patient’s blood glucose was measured on an hourly basis and their serum electrolytes and anion gap were measured for every 2 hours. Results: Among the intra-group comparison the serum sodium and chloride levels showed a statistically significant increase among the patients treated with normal saline (Group A) and plasmalyte (Group C). Serum potassium levels had shown a statistically significant increase among the patients treated with ringer lactate (Group B) and plasmalyte (Group C) and the serum bicarbonate levels had shown a statistically significant increase among all the three groups. Among the inter-group comparison serum potassium and bicarbonates level showed a more significant increase in plasmalyte group than that of the patients who received normal saline and ringer lactate. Among the three groups DKA status had resolved more early in the patients who had received plasmalyte, six patients in this group had got the DKA status resolved in 6 hrs and another eleven patients had got DKA resolved in 8 hrs and for the remaining 23 patients it got resolved in 10 hrs. Conclusion: In patients with diabetic ketoacidosis which is considered as a life-saving emergency condition should be treated promptly with a better I.V. fluid which would resolve the condition at the earliest. In our study it was proven that the plasmalyte was a better crystalloid than 0.9% NS and RL in resolving DKA at a faster rate.