A Randomized Control trial to Compare Balanced Salt Solution with Normal Saline for fluid resuscitation in pateints with Diabetic Ketoacidosis reporting to Emergency Department.

Along with insulin therapy, intravenous fluid administration to expand intravascular, interstitial, and intracellular volume is a key component of the acute management of diabetic ketoacidosis (DKA).1-3 Saline (0.9% sodium chloride, also called normal saline) is the most commonly used fluid for this purpose and the primary fluid recommended in current DKA clinical practice guidelines.1-3 The chloride concentration in saline (154 mmol/L) is higher than that in human plasma (94-111 mmol/L), which can cause hyperchloremic metabolic acidosis, especially when administered in large volumes.4-7 Although the clinical outcomes of saline infusion remain incompletely understood, accumulating evidence suggests that saline may increase the risk of kidney injury and impair recovery from severe illness, possibly because of the induction of metabolic acidosis.8-13. Balanced salt solution(BSS), including Ringer lactate and Plasma-Lyte A contain

chloride concentrations similar to those in human plasma and do not induce metabolic acidosis.4-7 Therefore, treatment of DKA with balanced salt solution rather than saline may lead to faster resolution of DKA.14-17