{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T16:02:44Z","timestamp":1792598564884,"version":"4.5.0"},"reference-count":32,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2022,7,1]],"date-time":"2022-07-01T00:00:00Z","timestamp":1656633600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2022,7,1]],"date-time":"2022-07-01T00:00:00Z","timestamp":1656633600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2022,7,1]],"date-time":"2022-07-01T00:00:00Z","timestamp":1656633600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-017"},{"start":{"date-parts":[[2022,7,1]],"date-time":"2022-07-01T00:00:00Z","timestamp":1656633600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-037"},{"start":{"date-parts":[[2022,7,1]],"date-time":"2022-07-01T00:00:00Z","timestamp":1656633600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-012"},{"start":{"date-parts":[[2022,7,1]],"date-time":"2022-07-01T00:00:00Z","timestamp":1656633600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-029"},{"start":{"date-parts":[[2022,7,1]],"date-time":"2022-07-01T00:00:00Z","timestamp":1656633600000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-004"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","heartandlung.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Heart & Lung"],"published-print":{"date-parts":[[2022,7]]},"DOI":"10.1016\/j.hrtlng.2022.03.014","type":"journal-article","created":{"date-parts":[[2022,3,28]],"date-time":"2022-03-28T18:57:36Z","timestamp":1648493856000},"page":"74-79","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":37,"special_numbering":"C","title":["Balanced electrolyte solutions versus isotonic saline in adult patients with diabetic ketoacidosis: A systematic review and meta-analysis"],"prefix":"10.1016","volume":"54","author":[{"given":"Jesus Alfonso","family":"Catahay","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edgar Theodore","family":"Polintan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Casimiro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kin Israel","family":"Notarte","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline Veronica","family":"Velasco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abbygail Therese","family":"Ver","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriel","family":"Pastrana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Imee","family":"Macaranas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Patarroyo-Aponte","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin Bryan","family":"Lo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"issue":"12","key":"10.1016\/j.hrtlng.2022.03.014_bib0001","doi-asserted-by":"crossref","first-page":"362","DOI":"10.15585\/mmwr.mm6712a3","article-title":"Trends in Diabetic Ketoacidosis Hospitalizations and In-Hospital Mortality \u2014 United States, 2000\u20132014","volume":"67","author":"Benoit","year":"2018","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"10.1016\/j.hrtlng.2022.03.014_bib0002","unstructured":"Singh S, Kerndt C, Davis D. Ringer's Lactate [Internet]. StatPearls. 2021 [cited 5 January 2022]. Available from: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK500033\/"},{"issue":"1","key":"10.1016\/j.hrtlng.2022.03.014_bib0003","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/j.transci.2018.02.021","article-title":"0.9% NaCl (Normal Saline) \u2013 Perhaps not so normal after all?","volume":"57","author":"Blumberg","year":"2018","journal-title":"Transfus Apheresis Sci"},{"issue":"1","key":"10.1016\/j.hrtlng.2022.03.014_bib0004","doi-asserted-by":"crossref","DOI":"10.1186\/s13054-016-1217-5","article-title":"Crystalloid fluid therapy","volume":"20","author":"Reddy","year":"2016","journal-title":"Crit Care"},{"issue":"12","key":"10.1016\/j.hrtlng.2022.03.014_bib0005","doi-asserted-by":"crossref","first-page":"2739","DOI":"10.2337\/dc06-9916","article-title":"Hyperglycemic crises in adult patients with diabetes: a consensus statement from the American Diabetes Association","volume":"29","author":"Kitabchi","year":"2006","journal-title":"Diabetes Care"},{"key":"10.1016\/j.hrtlng.2022.03.014_bib0006","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1186\/s13643-019-1130-5","article-title":"Choice of crystalloid fluid in the treatment of hyperglycemic emergencies: a systematic review protocol","volume":"8","author":"Gershkovich","year":"2019","journal-title":"Syst Rev"},{"issue":"4","key":"10.1016\/j.hrtlng.2022.03.014_bib0007","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1093\/qjmed\/hcr226","article-title":"Fluid management in diabetic-acidosis\u2013Ringer\u2019s lactate versus normal saline: a randomized controlled trial","volume":"105","author":"Van Zyl","year":"2012","journal-title":"QJM"},{"key":"10.1016\/j.hrtlng.2022.03.014_bib0008","series-title":"Cochrane Handbook for Systematic Reviews of Interventions version 6.2 (updated February 2021)","year":"2021"},{"key":"10.1016\/j.hrtlng.2022.03.014_bib0009","series-title":"Copenhagen: The Nordic Cochrane Centre","year":"2014"},{"issue":"13","key":"10.1016\/j.hrtlng.2022.03.014_bib0010","article-title":"Estimating the mean and variance from the median, range, and the size of a sample","volume":"5","author":"Hozo","year":"2005","journal-title":"BMC Med Res Methodol"},{"issue":"7414","key":"10.1016\/j.hrtlng.2022.03.014_bib0011","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1136\/bmj.327.7414.557","article-title":"Measuring inconsistency in meta-analyses","volume":"327","author":"Higgins","year":"2003","journal-title":"BMJ"},{"issue":"5","key":"10.1016\/j.hrtlng.2022.03.014_bib0012","doi-asserted-by":"crossref","first-page":"e236","DOI":"10.1097\/PEC.0000000000001550","article-title":"Resuscitation With Ringer\u2019s Lactate Compared With Normal Saline for Pediatric Diabetic Ketoacidosis","volume":"37","author":"Bergmann","year":"2021","journal-title":"Pediatr Emerg Care"},{"issue":"1","key":"10.1016\/j.hrtlng.2022.03.014_bib0013","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1111\/jpc.13436","article-title":"Controlled trial of Hartmann\u2019s solution versus 0.9% saline for diabetic ketoacidosis","volume":"53","author":"Yung","year":"2017","journal-title":"J Paediatr Child Health"},{"issue":"1","key":"10.1016\/j.hrtlng.2022.03.014_bib0014","doi-asserted-by":"crossref","DOI":"10.1186\/s13054-019-2683-3","article-title":"Rawat A. 0.9% saline versus Plasma-Lyte as initial fluid in children with diabetic ketoacidosis (SPinK trial): a double-blind randomized controlled trial","volume":"24","author":"Williams","year":"2020","journal-title":"Crit Care"},{"issue":"6","key":"10.1016\/j.hrtlng.2022.03.014_bib0015","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1016\/j.ajem.2010.02.004","article-title":"Resuscitation with balanced electrolyte solution prevents hyperchloremic metabolic acidosis in patients with diabetic ketoacidosis","volume":"29","author":"Mahler","year":"2011","journal-title":"Am J Emerg Med"},{"issue":"2","key":"10.1016\/j.hrtlng.2022.03.014_bib0016","doi-asserted-by":"crossref","first-page":"134","DOI":"10.13181\/mji.v26i2.1542","article-title":"The effect of balanced electrolyte solution versus normal saline in the prevention of hyperchloremic metabolic acidosis in diabetic ketoacidosis patients: a randomized controlled trial","volume":"26","author":"Aditianingsih","year":"2017","journal-title":"Med J Indonesia"},{"key":"10.1016\/j.hrtlng.2022.03.014_bib0017","series-title":"Using Balanced Electrolyte Solution versus Normal Saline For Fluid Resuscitation in Diabetic Ketoacidosis \u2013 a Randomized Clinical Trial. [Master of Science]","author":"Tsui","year":"2021"},{"issue":"11","key":"10.1016\/j.hrtlng.2022.03.014_bib0018","first-page":"1248","article-title":"SCOPE-DKA Collaborators and Queensland Critical Care Research Network (QCCRN). Sodium chloride or Plasmalyte-148 evaluation in severe diabetic ketoacidosis (SCOPE-DKA): a cluster, crossover, randomized, controlled trial","volume":"47","author":"Ramanan","year":"2021","journal-title":"Intensive Care Med"},{"issue":"11","key":"10.1016\/j.hrtlng.2022.03.014_bib0019","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2020.24596","article-title":"Clinical Effects of Balanced Crystalloids vs Saline in Adults With Diabetic Ketoacidosis","volume":"3","author":"Self","year":"2020","journal-title":"JAMA Netw Open"},{"issue":"11","key":"10.1016\/j.hrtlng.2022.03.014_bib0020","doi-asserted-by":"crossref","first-page":"2072","DOI":"10.1016\/j.ajem.2019.02.045","article-title":"Balanced crystalloids versus normal saline for fluid resuscitation in critically ill patients: a systematic review and meta-analysis with trial sequential analysis","volume":"37","author":"Liu","year":"2019","journal-title":"Am J Emerg Med"},{"issue":"1","key":"10.1016\/j.hrtlng.2022.03.014_bib0021","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1177\/1060028019866420","article-title":"Balanced Crystalloids Versus Saline in Critically Ill Adults: a Systematic Review and Meta-analysis","volume":"54","author":"Hammond","year":"2019","journal-title":"Ann Pharmacother"},{"issue":"1","key":"10.1016\/j.hrtlng.2022.03.014_bib0022","doi-asserted-by":"crossref","DOI":"10.1186\/s40560-018-0320-x","article-title":"Balanced crystalloids versus isotonic saline in critically ill patients: systematic review and meta-analysis","volume":"6","author":"Zayed","year":"2018","journal-title":"J Intensive Care"},{"issue":"1","key":"10.1016\/j.hrtlng.2022.03.014_bib0023","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1097\/EDE.0b013e3181c1ea43","article-title":"The Hazards of Hazard Ratios","volume":"21","author":"Hern\u00e1n","year":"2010","journal-title":"Epidemiology"},{"issue":"2","key":"10.1016\/j.hrtlng.2022.03.014_bib0024","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1007\/s10654-013-9770-6","article-title":"Unmeasured confounding and hazard scales: sensitivity analysis for total, direct, and indirect effects","volume":"28","author":"VanderWeele","year":"2013","journal-title":"Eur J Epidemiol"},{"key":"10.1016\/j.hrtlng.2022.03.014_bib0025","unstructured":"Agravat M. Effect Modification, Confounding,Hazard Ratio, Distribution Analysis, and Probability of Non-normal Data for Head Neck Cancer. 2011. Available from https:\/\/support.sas.com\/resources\/papers\/proceedings12\/315-2012.pdf"},{"key":"10.1016\/j.hrtlng.2022.03.014_bib0026","doi-asserted-by":"crossref","first-page":"255","DOI":"10.2147\/DMSO.S50516","article-title":"Management of adult diabetic ketoacidosis","volume":"7","author":"Gosmanov","year":"2014","journal-title":"Diabetes Metab Syndr Obes"},{"issue":"1","key":"10.1016\/j.hrtlng.2022.03.014_bib0027","first-page":"15","article-title":"Hidrataci\u00f3n en la cetoacidosis diab\u00e9tica. C\u00f3mo influye la velocidad de infusi\u00f3n? [Hydration in diabetic ketoacidosis. What is the effect of the infusion rate?]","volume":"57","author":"Caputo","year":"1997","journal-title":"Medicina (B Aires)"},{"issue":"11","key":"10.1016\/j.hrtlng.2022.03.014_bib0028","doi-asserted-by":"crossref","first-page":"1969","DOI":"10.1590\/S1807-59322011001100019","article-title":"Impact of Plasma-Lyte pH 7.4 on acid-base status and hemodynamics in a model of controlled hemorrhagic shock","volume":"66","author":"Noritomi","year":"2011","journal-title":"Clinics"},{"issue":"1","key":"10.1016\/j.hrtlng.2022.03.014_bib0029","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1213\/ane.0b013e3181732d64","article-title":"The Effect of Different Crystalloid Solutions on Acid-Base Balance and Early Kidney Function After Kidney Transplantation","volume":"107","author":"Hadimioglu","year":"2008","journal-title":"Anesthesia Analgesia"},{"issue":"12","key":"10.1016\/j.hrtlng.2022.03.014_bib0030","first-page":"1288","article-title":"The effects of plasmalyte-148vs. Hartmann\u2019s solution during major liver resection: a multicentre, double-blind, randomized controlled trial","volume":"81","author":"Weinberg","year":"2015","journal-title":"Minerva Anestesiol"},{"issue":"4","key":"10.1016\/j.hrtlng.2022.03.014_bib0031","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1016\/j.jemermed.2015.12.003","article-title":"Effect of Volume of Fluid Resuscitation on Metabolic Normalization in Children Presenting in Diabetic Ketoacidosis: a Randomized Controlled Trial","volume":"50","author":"Bakes","year":"2016","journal-title":"J Emerg Med"},{"key":"10.1016\/j.hrtlng.2022.03.014_bib0032","article-title":"What is GRADE? [Internet]","author":"Siemieniuk","year":"2022","journal-title":"BMJ Best Practice"}],"container-title":["Heart & Lung"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0147956322000681?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0147956322000681?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,9,27]],"date-time":"2025-09-27T06:39:24Z","timestamp":1758955164000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0147956322000681"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7]]},"references-count":32,"alternative-id":["S0147956322000681"],"URL":"https:\/\/doi.org\/10.1016\/j.hrtlng.2022.03.014","relation":{"has-review":[{"id-type":"doi","id":"10.3410\/f.742695243.793599147","asserted-by":"object"}]},"ISSN":["0147-9563"],"issn-type":[{"value":"0147-9563","type":"print"}],"subject":[],"published":{"date-parts":[[2022,7]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Balanced electrolyte solutions versus isotonic saline in adult patients with diabetic ketoacidosis: A systematic review and meta-analysis","name":"articletitle","label":"Article Title"},{"value":"Heart & Lung","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.hrtlng.2022.03.014","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2022 Elsevier Inc. All rights reserved.","name":"copyright","label":"Copyright"}]}}