Abstract
Traditionally, normal saline solution (NSS) has been the fluid of choice in diabetic ketoacidosis (DKA) patients, but the NSS is an acidic fluid and may lead to the delayed resolution of DKA. A systemic review search was conducted on PubMed, Embase, and Central Cochrane Registry to compare the efficacy of low chloride solutions with normal saline solution in DKA resolution. Randomized clinical trials with normal saline as a control arm and low chloride solutions as an intervention arm were included. Four studies were included in the analysis. The investigated outcomes, including time to resolution for DKA and duration of insulin infusion, varied depending on the endpoint were reported in the studies. Overall, balanced solutions were generally associated with faster correction of pH. The time to reach overall DKA endpoints was comparable in both groups. We concluded that crystalloid solutions may be used as an initial resuscitation fluid in the DKA population and may lead to earlier resolution of acidosis. More clinical trial data is required to reach statistical significance for the hypothesis.
Highlights
BackgroundDiabetic ketoacidosis (DKA) is an acute emergency consisting of a triad of hyperglycemia, ketonemia, and high anion gap metabolic acidosis (HAGMA) [1]
A systemic review search was conducted on PubMed, Embase, and Central Cochrane Registry to compare the efficacy of low chloride solutions with normal saline solution in diabetic ketoacidosis (DKA) resolution
There has been debate about the best choice of fluid for DKA resuscitation, and in this analysis, we review different clinical trials and publications where balanced/low chloride IV solution (such as lactated Ringers (LR), plasmalyte) is compared with high chloride IV solution
Summary
Diabetic ketoacidosis (DKA) is an acute emergency consisting of a triad of hyperglycemia, ketonemia, and high anion gap metabolic acidosis (HAGMA) [1]. DKA is a volume-depleted state, and a typical adult patient will have a water deficit of 100 mL/kg [5]. The goals of DKA management include volume expansion via intravenous (IV) fluids along with correction of ketosis and electrolyte repletion via insulin drip and parenteral electrolyte supplementation. There has been debate about the best choice of fluid for DKA resuscitation, and in this analysis, we review different clinical trials and publications where balanced/low chloride IV solution (such as lactated Ringers (LR), plasmalyte) is compared with high chloride IV solution (normal saline solution)
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