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Review
. 2022 Jan 6;4(1):e0613.
doi: 10.1097/CCE.0000000000000613. eCollection 2022 Jan.

Saline Compared to Balanced Crystalloid in Patients With Diabetic Ketoacidosis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Naif Ali Alghamdi  1   2 , Paityn Major  1 , Dipayan Chaudhuri  1 , Janice Tsui  3 , Brent Brown  4 , Wesley H Self  5   6 , Matthew W Semler  7 , Mahesh Ramanan  8   9   10 , Bram Rochwerg  1   11
Affiliations
Review

Saline Compared to Balanced Crystalloid in Patients With Diabetic Ketoacidosis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Naif Ali Alghamdi et al. Crit Care Explor. .

Abstract

Objectives: This systematic review and meta-analysis compared the use of saline to balanced crystalloid for fluid resuscitation in patients with diabetic ketoacidosis (DKA).

Data sources: We searched databases including Medline, Embase, and the Cochrane registry.

Study selection: We included randomized controlled trials (RCTs) that compared saline to balanced crystalloid in patients with DKA.

Data extraction: We pooled estimates of effect using relative risk for dichotomous outcomes and mean differences (MDs) for continuous outcomes, both with 95% CIs. We assessed risk of bias for included RCTs using the modified Cochrane tool and certainty of evidence using Grading of Recommendations, Assessment, Development, and Evaluation methodology.

Data synthesis: We included eight RCTs (n = 482 patients). Both time to DKA resolution (MD, 3.51 hr longer; 95% CI, 0.90 longer to 6.12 longer; moderate certainty) and length of hospital stay (MD, 0.89 d longer in saline group; 95% CI, 0.34 longer to 1.43 d longer; moderate certainty) are probably longer in the saline group compared with the balanced crystalloid group, although for the latter, the absolute difference (under 1 d) is small. Post-resuscitation serum chloride level may be higher (MD, 1.62 mmol/L higher; 95% CI, 0.40 lower to 3.64 higher; low certainty), and post-resuscitation serum bicarbonate is probably lower (MD, 1.50 mmol/L; 95% CI, 2.33 lower to 0.67 lower; moderate certainty) in those receiving saline.

Conclusions: In patients with DKA, the use of saline may be associated with longer time to DKA resolution, higher post-resuscitation serum chloride levels, lower post-resuscitation serum bicarbonate levels, and longer hospital stay compared with balanced crystalloids. Pending further data, low to moderate certainty data support using balanced crystalloid over saline for fluid resuscitation in patients with DKA.

Keywords: diabetic ketoacidosis; fluid resuscitation; saline and balanced crystalloids.

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Conflict of interest statement

Dr. Self received funding in May 2019 from Baxter Healthcare Corporation to speak at an educational conference on intravenous fluid use. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Study flow diagram.
Figure 2.
Figure 2.
Effect of using either saline or balanced crystalloids (BCs) on time to diabetic ketoacidosis resolution (hr). df = degrees of freedom.
Figure 3.
Figure 3.
Effect of using either saline or balanced crystalloids (BCs) on length of hospital stay (d). df = degrees of freedom.
Figure 4.
Figure 4.
Effect of using either saline or balanced crystalloids (BCs) on post-resuscitation bicarbonate. df = degrees of freedom.
See this image and copyright information in PMC

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