Evidence map›Paper›PMID 34609547›Full record

Trial reportIntensive care medicine2021

Sodium chloride or Plasmalyte-148 evaluation in severe diabetic ketoacidosis (SCOPE-DKA): a cluster, crossover, randomized, controlled trial.

Mahesh Ramanan, Antony Attokaran, Lauren Murray, Neeraj Bhadange, David Stewart, Gokulnath Rajendran, Raju Pusapati, Melissa Petty, Peter Garrett, Peter Kruger and 4 more

Abstract readRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in Intensive care medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 34 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
34citing papers in PubMed, 1 pooled it
4.7field-weighted citation impact, top 4% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

34 citing papers in PubMed, 1 synthesis or guideline pooled it, 44 citations in OpenAlex.

  1. Pooled it
  2. Trial
  3. Trial
  4. Trial
  5. Research priorities for intensive care: A stakeholder-informed priority-setting partnership.Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine · 2026
    Article
  6. Review
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  10. Pediatric Diabetic Ketoacidosis: Comparing Outcomes of Potassium Acetate Versus Potassium Chloride Using the Two-Bag System.The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG · 2025
    Article
  11. Review
  12. Article
  13. Review
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  15. Review
  16. Intravenous Fluid Prescription in Diabetic Ketoacidosis: Where is the Evidence?Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2025
    Article
  17. Effectiveness of Balanced Electrolyte Solution vs Normal Saline in the Resuscitation of Adult Patients with Diabetic Ketoacidosis: An Updated Systematic Review and Meta-analysis.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2025
    Article
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

14 authors at 1 institution in 1 country.

Mahesh RamananIntensive Care Unit, Caboolture Hospital, McKean Street, Caboolture, QLD, 4510, Australia. Mahesh.ramanan@health.qld.gov.au.ORCID 0000-0003-4509-4015
Antony AttokaranIntensive Care Unit, Rockhampton Hospital, Canning Street, Rockhampton, QLD, 4700, Australia.
Lauren MurrayIntensive Care Unit, Sunshine Coast University Hospital, Doherty Street, Birtinya, QLD, 4575, Australia.
Neeraj BhadangeIntensive Care Unit, Ipswich Hospital, Chelmsford Avenue, Ipswich, QLD, 4305, Australia.
David StewartIntensive Care Unit, Queen Elizabeth-2 Jubilee Hospital, Kessels Road, Coopers Plains, QLD, 4108, Australia.
Gokulnath RajendranIntensive Care Unit, Mackay Base Hospital, Bridge Road, Mackay, QLD, 4741, Australia.
Raju PusapatiIntensive Care Unit, Hervey Bay Hospital, Urraween Road, Pialba, QLD, 4655, Australia.
Melissa PettyIntensive Care Unit, Caboolture Hospital, McKean Street, Caboolture, QLD, 4510, Australia.
Peter GarrettIntensive Care Unit, Sunshine Coast University Hospital, Doherty Street, Birtinya, QLD, 4575, Australia.
Peter KrugerIntensive Care Unit, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, QLD, 4102, Australia.
Sandra PeakeDepartment of Intensive Care Medicine, The Queen Elizabeth Hospital, Woodville Road, Woodville South, South Australia, 5011, Australia.
Laurent BillotThe George Institute for Global Health, University of New South Wales, Level 5/1 King Street, Newtown, NSW, 2042, Australia.
Balasubramanian VenkateshThe George Institute for Global Health, University of New South Wales, Level 5/1 King Street, Newtown, NSW, 2042, Australia.
SCOPE-DKA Collaborators and Queensland Critical Care Research Network (QCCRN)
Princess Alexandra Hospital · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeTo determine whether treatment with Plasmalyte-148 (PL) compared to sodium chloride 0.9% (SC) results in faster resolution of diabetic ketoacidosis (DKA) and whether the acetate in PL potentiates ketosis.

methodsWe conducted a cluster, crossover, open-label, randomized, controlled Phase 2 trial at seven hospitals in adults admitted to intensive care unit (ICU) with severe DKA with hospital randomised to PL or SC as fluid therapy. The primary outcome, DKA resolution, was defined as a change in base excess to ≥ - 3 mEq/L at 48 h.

resultsNinety-three patients were enrolled with 90 patients included in the modified-intention-to-treat population (PL n = 48, SC n = 42). At 48 h, mean fluid administration was 6798 ± 4850 ml vs 6574 ± 3123 ml, median anion gap 6 mEq/L (IQR 5-7) vs 7 mEq/L (IQR 5-7) and median blood ketones 0.3 mmol/L (IQR 0.1-0.5) vs 0.3 (IQR 0.1-0.5) in the PL and SC groups. DKA resolution at 48 h occurred in 96% (PL) and 86% (SC) of patients; odds ratio 3.93 (95% CI 0.73-21.16, p = 0.111). At 24 h, DKA resolution occurred in 69% (PL) and 36% (SC) of patients; odds ratio 4.24 (95% CI 1.68-10.72, p = 0.002). The median ICU and hospital lengths of stay were 49 h (IQR 23-72) vs 55 h (IQR 41-80) and 81 h (IQR 58-137) vs 98 h (IQR 65-195) in the PL and SC groups.

conclusionPlasmalyte-148, compared to sodium chloride 0.9%, may lead to faster resolution of metabolic acidosis in patients with DKA without an increase in ketosis. These findings need confirmation in a large, Phase 3 trial.

Indexed as

Diabetic KetoacidosisAdultCross-Over StudiesFluid TherapyHumansSaline SolutionSodium ChlorideSaline SolutionSodium ChlorideCritical careDiabetesDiabetic ketoacidosisFluid therapyPlasmalyte-148Sodium chloride

Identifiers

PMID34609547
OpenAlexW3203302168

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.