ReviewCureus2026
Balanced Crystalloids Versus Normal Saline for Fluid Resuscitation in Patients With Diabetic Ketoacidosis: A Systematic Review.
Review in Cureus, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Diabetic ketoacidosis (DKA) is a life-threatening metabolic complication of diabetes mellitus requiring aggressive intravenous fluid resuscitation. Although the recommended fluid has always been 0.9% normal saline (NS), its supraphysiological chloride load may induce hyperchloremic metabolic acidosis, potentially complicating DKA management. Balanced crystalloids (BCs), with electrolyte compositions more closely approximating human plasma, have emerged as potentially advantageous alternatives. This systematic review compares the clinical outcomes of NS with BCs for fluid resuscitation in patients with DKA. A comprehensive literature search was conducted in PubMed/MEDLINE, Scopus, Embase, and CENTRAL (2021-2026) following PRISMA guidelines. Studies that directly compared 0.9% NS with BCs (such as lactated Ringer's (LR) solution, Plasma-Lyte 148, Isolyte, Sterofundin, or other balanced electrolyte solutions (BES)) for DKA resuscitation were included. The outcomes of interest included time to DKA resolution, electrolyte profiles, insulin infusion duration, length of stay (LOS), acute kidney injury (AKI), and mortality. The risk of bias (ROB) was assessed using the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) (for non-randomized studies) and RoB 2 (for randomized controlled trials (RCTs)). Nine studies, four RCTs and five non-randomized studies, comprising 1416 patients, met the inclusion criteria. BCs consistently reduced hyperchloremia and improved bicarbonate profiles compared with NS. Insulin infusion duration was significantly shorter with BCs in two studies. Length-of-stay outcomes were mixed, with some studies showing shorter hospital or ICU stays with BCs. No significant differences in AKI incidence or mortality were observed between groups. The ROB ranged from moderate to substantial, although the RCTs demonstrated a lower ROB than the retrospective cohort studies. BCs demonstrated superior electrolyte profiles and comparable safety compared with NS in DKA. However, their effect on clinically meaningful outcomes such as time to DKA resolution remains uncertain. While the biochemical advantages support consideration of BC, definitive practice recommendations await higher-certainty evidence.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.