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Review
. 2022 Jan 17;14(1):e21324.
doi: 10.7759/cureus.21324. eCollection 2022 Jan.

Normal Saline Versus Low Chloride Solutions in Treatment of Diabetic Ketoacidosis: A Systematic Review of Clinical Trials

Ahmad Jahangir  1 , Abdullah Jahangir  2 , Fasih Sami Siddiqui  3 , Muhammad Rafay Khan Niazi  3 , Fahad Yousaf  3 , Marwah Muhammad  4 , Syeda Sahra  5 , Aneeqa Javed  5 , Muhammad Ans Sharif  1 , Qasim Zafar Iqbal  6 , Michael Krzyzak  3
Affiliations
Review

Normal Saline Versus Low Chloride Solutions in Treatment of Diabetic Ketoacidosis: A Systematic Review of Clinical Trials

Ahmad Jahangir et al. Cureus. .

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.

Keywords: crystalloid solutions; diabetes mellitus; diabetic ketoacidosis; dka; hyperglycemia; insulin; lactated ringer; normal saline.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Risk of bias graph in studies included
Figure 2
Figure 2. Risk of bias summary for the included studies
Figure 3
Figure 3. PRISMA 2009 flow sheet for selection of studies
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses
See this image and copyright information in PMC

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