Comparing Sterofundin to 0.9% Sodium Chloride Infusion in Managing Diabetic Ketoacidosis: A Pilot Study

Fluid  replacement  is  the  mainstay  treatment  for  diabetic  ketoacidosis  (DKA). Currently, the best choice of fluids is still debatable. An amount of 0.9% sodium chloride  is  commonly  used.  Sterofundin®  is  an  alternative  crystalloid  that  is assumed  to  expedite  resolution  of  acidosis.  Advantages  in  sterofundin  content being smaller significant ion difference (SID) to plasma and lower chloride content. The main objective of the study was to compare rate of acidosis resolution in DKA patients between treatment with 0.9% normal saline and Sterofundin over 12 hrs. Other  objectives  were  to  compare  significant  ion  difference  (SID),  12-hr  blood ketone clearance and electrolyte balance between the two groups. The study was a prospective open labelled randomized control trial. This study was conducted over 6 months. Sample size of 18 was obtained with 9 for each arm. Main difference between two groups was initial median 2-hr pH level improvement (NS = +0.006 vs.  Sterofundin  =  +0.05,  P=0.063),  however  not  being  significant.  Ketone,  anion gap reduction, bicarbonate normalisation, sodium, chloride, urea and creatinine levels failed to show any significant differences between both groups. Twelve-hour median  chloride  levels  increments  were  higher  in  the  NS  group  (+11)  compared to  the  sterofundin  group  (+6).  There  was  no  difference  between  mortality  and morbidity. Comparing the two fluid groups, there was no significant biochemical differences during treatment of DKA. This was a pilot study that can initiate further clinical trials.