Fluid therapy in severe diabetic ketoacidosis

New funding for research to help inform critical care practice in Australia and internationally

The George Institute’s Critical Care team have secured funding to address gaps in evidence that have led to uncertainties around the best choice of treatment in the intensive care setting with great potential to reduce hospital costs as well as deaths and disability. 

The grants are part of the Australian Government’s Medical Research Future Fund Clinical Trials Activity grants round, designed to evaluate effective health interventions that address unmet needs.

Defining the best choice of fluid therapy in severe diabetic ketoacidosis

Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes in which the body produces excess blood acids known as ketones. It occurs when there isn't enough insulin in the body and can be triggered by infection or other illness.

The incidence is rising in Australia, particularly in metropolitan and rural or regional hospitals - approximately 3,000 people with the condition are admitted to Australian ICUs each year, according to data stored at the Australia New Zealand Intensive Care Society registries.

Fluid therapy is a vital component of the treatment of DKA, but which fluid provides the best outcomes is unknown. Saline is widely recommended in national and international guidelines despite a lack of high-quality evidence to support its use. It can lead to complications associated with worse outcomes in critically ill patients.

An alternative fluid, Plasma-Lyte 148 – a balanced salt solution which more closely matches the biochemistry of human blood - has theoretical advantages over saline and is recommended in some DKA guidelines.

Dr Mahesh Ramanan, Intensive Care Specialist at Caboolture Hospital and The Prince Charles Hospital, Queensland, and PhD student at The George Institute, will work with the Critical Care Division at The George Institute and other clinician-researchers around Australia to conduct a clinical trial evaluating whether Plasma-Lyte compared with normal saline increases days alive and out of hospital in patients with DKA.

It is hoped that the results will provide definitive guidance on the best choice of fluid therapy in DKA and reduce healthcare costs by reducing the time patients need to spend in ICU and hospital.

Improving outcomes for younger people with a debilitating form of stroke

A subarachnoid haemorrhage is a devastating type of stroke affecting around 2000 Australians a year, a third of whom will die from the condition with the remainder at risk of permanent disability. Up to 40% of this often young and previously fit population are unable to return to their previous occupation. Despite the impact of this condition, there has been no new treatment shown to improve outcomes for these patients over the last 15 years.

A common complication in this type of stroke is low blood levels of sodium (or hyponatremia) which occurs in up to two thirds of hospitalised patients. Hyponatremia is associated with a twofold increase in duration of hospital and ICU stay in these patients.

Previous work by Dr Jeremy Cohen, Director of the Wesley Hospital Intensive Care Unit and Honorary Professorial Fellow at The George Institute, confirmed that hyponatraemia during ICU admission is also significantly associated with worse levels of disability six months later.

This study will investigate if fludrocortisone, a low cost and well-established corticosteroid that regulates salt and water balance in the body, can prevent this fall in sodium and therefore improve outcomes in these patients. 

It will be the only multi-centre, randomised, double blinded trial involving enough patients with this condition to be able to detect clinically meaningful functional outcomes and is therefore likely to have a substantial impact upon clinical practice.