Balanced Multi-Electrolyte Solution Versus Saline Trial for Diabetic KetoAcidosis

The goal of this blinded, cluster cross-over, randomised controlled trial is to determine whether fluid therapy with Plasma-Lyte® 148 increases the number of days alive and days out of hospital to day-28 compared to 0.9% sodium chloride ('0.9% saline') in critically ill patients presenting to the Emergency Department (ED) and deemed to require admission to a critical care area (ICU, HDU) with moderate to severe diabetic ketoacidosis (DKA).

Inclusion Criteria: * Patients in the ED with a primary diagnosis of moderate to severe DKA for whom both saline and Plasma-Lyte® 148 are considered appropriate fluids * Blood glucose level \> 14mmol/L * pH \< 7.25 * Serum bicarbonate \ 12mEq/L * Ketones positive on finger prick measurements * In the judgement of the treating clinician critical care area admission is required Exclusion Criteria: * Age less than 18 years * Patients who have received more than 2000ml of non study fluid prior to study enrolment * Serum Na \> 155 or \