Caboolture ICU part of Diabetic Ketoacidosis Trial

Caboolture Hospital will lead a new trial into fluid therapy for specific ICU patients thanks to a grant from the Emergency Medicine Foundation (EMF).

Co-investigator, Caboolture ICU specialist Dr Mahesh Ramanan, said the grant of close to $165k will allow the team to compare two commonly used fluid therapies given to patients admitted to ICU with diabetic ketoacidosis (DKA).

“ICU admission rates for patients with DKA in Australia have risen annually over the last decade,” said Dr Ramanan said.

“DKA is a life-threatening complication of diabetes mellitus, which was universally fatal before insulin was discovered.”

“It results in elevated acid levels in the blood leading to severe dehydration and electrolyte imbalance. Intravenous fluids (IV) are one of the main cornerstones of therapy for DKA.

“Out of 7000 DKA admissions to hospital annually in Australia, approximately 2000-2500 end up becoming critically ill and requiring intensive care unit admission.”

The grant from EMF will allow the group to commence the BEST-DKA trial, which was designed in collaboration with colleagues from around Australia.

“The proposed trial will answer a fundamental clinical question of which type of fluid to use in DKA and will inform policy and practice in Australia and New Zealand and around the world,” Dr Ramanan said.

A pilot trial designed in 2018 and led by Caboolture Hospital, set out to address the question whether saline or plasmalyte was the best IV fluid to give severely dehydrated DKA patients.

“The pilot trial, conducted in seven Queensland metropolitan and regional emergency departments and ICUs, showed that the use of plasmalyte resulted in a more rapid resolution of acidosis,” Dr Ramanan said.

“There was evidence this could lead to shorter length of ICU and hospital stay as compared to saline.

“The BEST-DKA trial will definitely tell us whether plasmalyte is actually better than saline for patients with DKA. It will kick off across 20 Australian hospitals, including Caboolture and six other Queensland Hospitals this month.”