RT Journal Article SR Electronic T1 Balanced crystalloids (RInger’s lactate) versus normal Saline in adults with diabetic Ketoacidosis in the Emergency Department (BRISK-ED): a pilot randomised controlled trial JF Emergency Medicine Journal JO Emerg Med J FD BMJ Publishing Group Ltd and the British Association for Accident & Emergency Medicine SP 103 OP 111 DO 10.1136/emermed-2023-213290 VO 41 IS 2 A1 Yan, Justin W A1 Slim, Ahmed A1 Van Aarsen, Kristine A1 Choi, Yun-Hee A1 Byrne, Christopher A1 Poonai, Naveen A1 Collins, Haley A1 Clemens, Kristin K YR 2024 UL http://emj.bmj.com/content/41/2/103.abstract AB Background Current diabetic ketoacidosis (DKA) treatment guidelines recommend using normal saline (NS); however, NS may delay DKA resolution by causing more hyperchloremic metabolic acidosis compared with balanced crystalloids. This study’s objective was to determine the feasibility of a future multicentred randomised controlled trial (RCT) comparing intravenous Ringer’s lactate (RL) with NS in managing ED patients with DKA.Methods We conducted a parallel-arm, triple-blind, pilot RCT of adults (≥18 years) with DKA at a Canadian academic tertiary care ED. The primary feasibility outcome was recruitment rate (target ≥41.3% of eligible participants over the 1-year study period); the primary efficacy outcome was time elapsed from ED presentation to DKA resolution. The superiority margin for a clinically significant difference was chosen to be a 40% time reduction to DKA resolution. We also assessed the need to break allocation concealment and loss to follow-up. Patients with clinical suspicion for DKA were screened for inclusion and enrolled patients were randomised 1:1 to receive RL or NS. Patients, clinicians and outcome assessors were blinded to allocation.Results We enrolled 52 (25 RL, 27 NS) of 60 eligible patients (86.7%), exceeding our target recruitment rate. There were more patients in the NS group with type 1 diabetes, and more patients in the RL group had an admission co-diagnosis in addition to DKA. For the 44 participants with confirmed laboratory evidence of resolution, median (IQR) time to DKA resolution for RL versus NS was 15.7 (10.4–18.8) and 12.7 (7.9–19.2) hours, respectively. There were no cases where blinding was broken, and there was no loss to follow-up.Conclusions This pilot trial demonstrated our protocol’s feasibility by exceeding our target recruitment rate. Our results may be used to inform future multicentre trials to compare the safety and efficacy of RL and NS in managing DKA in the ED.Trial registration number NCT04926740.Data are available upon reasonable request.