{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T01:18:38Z","timestamp":1792631918540,"version":"4.5.0"},"reference-count":60,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,6,23]],"date-time":"2024-06-23T00:00:00Z","timestamp":1719100800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Metabolism Res"],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Fluid resuscitation during diabetic ketoacidosis (DKA) is most frequently performed with 0.9% saline despite its high chloride and sodium concentration. Balanced Electrolyte Solutions (BES) may prove a more physiological alternative, but convincing evidence is missing. We aimed to compare the efficacy of 0.9% saline to BES in DKA management. MEDLINE, Cochrane Library, and Embase databases were searched for relevant studies using predefined keywords (from inception to 27 November 2021). Relevant studies were those in which 0.9% saline (Saline\u2010group) was compared to BES (BES\u2010group) in adults admitted with DKA. Two reviewers independently extracted data and assessed the risk of bias. The primary outcome was time to DKA resolution (defined by each study individually), while the main secondary outcomes were changes in laboratory values, duration of insulin infusion, and mortality. We included seven randomized controlled trials and three observational studies with 1006 participants. The primary outcome was reported for 316 patients, and we found that BES resolves DKA faster than 0.9% saline with a mean difference (MD) of \u22125.36 [95% CI: \u221210.46, \u22120.26] hours. Post\u2010resuscitation chloride (MD: \u22124.26 [\u22126.97, \u22121.54] mmoL\/L) and sodium (MD: \u22121.38 [\u22122.14, \u22120.62] mmoL\/L) levels were significantly lower. In contrast, levels of post\u2010resuscitation bicarbonate (MD: 1.82 [0.75, 2.89] mmoL\/L) were significantly elevated in the BES\u2010group compared to the Saline\u2010group. There was no statistically significant difference between the groups regarding the duration of parenteral insulin administration (MD: 0.16 [\u22123.03, 3.35] hours) or mortality (OR: \u22120.67 [0.12, 3.68]). Studies showed some concern or a high risk of bias, and the level of evidence for most outcomes was low. This meta\u2010analysis indicates that the use of BES resolves DKA faster than 0.9% saline. Therefore, DKA guidelines should consider BES instead of 0.9% saline as the first choice during fluid resuscitation.<\/jats:p>","DOI":"10.1002\/dmrr.3831","type":"journal-article","created":{"date-parts":[[2024,6,24]],"date-time":"2024-06-24T02:13:55Z","timestamp":1719195235000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Fluid resuscitation with balanced electrolyte solutions results\u00a0in faster resolution of diabetic ketoacidosis than with\u00a00.9% saline in adults \u2013 A systematic review and meta\u2010analysis"],"prefix":"10.1002","volume":"40","author":[{"given":"Gerg\u0151 Vilmos","family":"Szab\u00f3","sequence":"first","affiliation":[{"name":"Centre for Translational Medicine Semmelweis University  Budapest Hungary"},{"name":"Emergency Department Szent Gy\u00f6rgy University Teaching Hospital of Fej\u00e9r County  Sz\u00e9kesfeh\u00e9rv\u00e1r Hungary"},{"name":"National Ambulance Service  Budapest Hungary"},{"name":"Hungarian Air Ambulance Nonprofit Ltd.  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