Table 1. Baseline Patient Characteristics by Assigned Treatment Group.
| Characteristic | Patients, No. (%) | |
|---|---|---|
| Balanced crystalloids (n = 94) | Saline (n = 78) | |
| Age, median (IQR), y | 28 (23-39) | 30 (25-49) |
| Women | 54 (57.4) | 36 (46.2) |
| Race | ||
| White | 66 (70.2) | 58 (74.4) |
| Non-White | 28 (29.8) | 20 (25.6) |
| Elixhauser Comorbidity Index Score, median (IQR)a | 5.0 (1.2-10.0) | 5.0 (2.0-10.8) |
| Type of diabetes | ||
| Type 1 | 82 (87.2) | 60 (76.9) |
| Type 2 | 12 (12.8) | 18 (23.1) |
| Baseline hemoglobin A1c, median (IQR), %b | 10.8 (9.2-12.6) | 11.3 (9.2-13.3) |
| Suspected cause of diabetic ketoacidosis | ||
| Newly diagnosed diabetes | 8 (8.5) | 3 (3.8) |
| Missed medication dose(s) | 52 (55.3) | 42 (53.8) |
| Infection | 16 (17.0) | 24 (30.8) |
| Otherc | 10 (10.6) | 6 (7.7) |
| Unknown | 8 (8.5) | 3 (3.8) |
| Diabetic ketoacidosis severity by initial plasma bicarbonate category in the ED | ||
| Mild (15-18 mmol/L) | 25 (26.6) | 25 (32.1) |
| Moderate (10-14 mmol/L) | 31 (33.0) | 24 (30.8) |
| Severe (<10 mmol/L) | 38 (40.4) | 29 (37.2) |
| Initial Glasgow Coma Scale score in the ED <15 | 11 (11.7) | 10 (12.8) |
| End-stage kidney disease with long-term kidney-replacement therapy at baseline | 5 (5.3) | 1 (1.3) |
| Baseline serum creatinine prior to acute illness, median (IQR), mg/dLd | 0.70 (0.60-0.87) | 0.74 (0.60-0.90) |
| Source of baseline creatinine prior to acute illness | ||
| Measured value in medical record | 70 (74.5) | 52 (66.7) |
| Calculated value by equation | 24 (25.5) | 26 (33.3) |
| Stage 2 or greater acute kidney injury based on first creatinine measurement in EDd,e | 56 (62.9) | 44 (57.1) |
| Initial plasma laboratory values in the ED, median (IQR) | ||
| Sodium, mEq/L | 133 (129-135) | 133 (130-136) |
| Chloride, mEq/L | 98 (94-101) | 97 (94-101) |
| Potassium, mEq/L | 4.6 (4.1-5.1) | 4.8 (4.4-5.5) |
| Bicarbonate, mEq/L | 11 (7-15) | 11 (7-16) |
| Creatinine, mg/dLd | 1.5 (1.2-2.0) | 1.5 (1.2-2.0) |
| Blood urea nitrogen, mg/dLd | 18 (13-27) | 20 (15-28) |
| Glucose, mg/dL | 557 (415-761) | 518 (373-750) |
| Anion gap, mEq/L | 22 (19-28) | 24 (19-29) |
Abbreviations: ED, emergency department; IQR, interquartile range.
SI conversion factors: To convert anion gap to millimoles per liter, multiply by 1.0; bicarbonate to millimoles per liter, multiply by 1.0; chloride to millimoles per liter, multiply by 1.0; creatinine to micromoles per liter, multiply by 88.4; glucose to millimoles per liter, multiply by 0.0555; hemoglobin A1c to proportion of total hemoglobin, multiply by 0.01; sodium to millimoles per liter, multiply by 1.0; potassium to millimoles per liter, multiply by 1.0; urea nitrogen to millimoles per liter, multiply by 0.357.
The Elixhauser Comorbidity Index score summarizes the burden of a patient’s coexisting conditions. Scores range from −19 to 89, with higher scores indicating a profile of coexisting conditions that is more strongly associated with in-hospital death.24
Eight patients had missing values for baseline hemoglobin A1C, including 5 patients in the balanced crystalloids group and 3 patients in the saline group.
Other suspected causes of DKA included pregnancy-related factors (3 patients in the balanced crystalloids group and 2 patients in the saline group), medication adverse effects (3 patients in the balanced crystalloids group), vomiting (2 patients in the balanced crystalloids group and 1 in the saline group), pancreatitis (1 patient in the balanced crystalloids group), gastrointestinal bleeding (1 patient in the balanced crystalloids group), heat exhaustion (1 patient in the saline group), trauma (1 patient in the saline group), and heart disease (1 patient in the saline group).
Six patients with baseline end-stage kidney disease with long-term kidney-replacement therapy were not included in the reported data for mean baseline serum creatinine prior to acute illness, source of baseline creatinine prior to acute illness, stage 2 or greater acute kidney injury in the ED, creatinine in the ED, and blood urea nitrogen in the ED.
Acute kidney injury was defined according to the Kidney Disease: Improving Global Outcomes creatinine criteria25: stage 2 or great acute kidney injury in ED defined as ED creatinine 200% or higher over baseline creatinine or ED creatinine greater than or equal to 4.0 mg/dL with an increase of at least 0.5 mg/dL over baseline creatinine.