Balanced Crystalloids No Faster Than Saline for DKA Resolution

This meta-analysis addresses whether the physiologic appeal of balanced crystalloids translates into faster resolution or better clinical outcomes when resuscitating patients with diabetic ketoacidosis.

balanced crystalloidsRinger's lactatePlasma-LyteHartmann's solutionnormal salinediabetic ketoacidosisfluid resuscitationmeta-analysiscritical careelectrolytes Critical Care / ICU

Background Information

No clear winner between balanced crystalloids and saline in DKA resuscitation.

Diabetic ketoacidosis (DKA) is a critical condition requiring effective fluid resuscitation to improve outcomes. Balanced crystalloids did not significantly reduce time to DKA resolution compared to normal saline and only improved serum bicarbonate levels at 12 hours. While balanced crystalloids increased serum bicarbonate levels, this did not translate to faster DKA resolution or clear clinical advantages, highlighting ongoing uncertainty in optimal fluid choice. The choice between balanced crystalloids and normal saline for DKA resuscitation lacks clear clinical superiority and requires further research.

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Authors: Soliman KAR, Hassan Ali AO, Ameer F, Alharbi B, Elmasry MH, Alwashmi RM, Alshreef BS, Almabouth MSH, Hardan KA, Alqurain AA

Citation: Soliman KAR, Hassan Ali AO, Ameer F, et al. Balanced crystalloids versus normal saline for initial fluid resuscitation in diabetic ketoacidosis: a systematic review and meta-analysis of randomized controlled trials. Journal of critical care medicine (Universitatea de Medicina si Farmacie din Targu-Mures). 2026;12(3):328-341. doi:10.62838/jccm-2026-0022

Article Links: PubMed · Journal / DOI · Free Full Text (PMC)

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Executive Summary

Study Design

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