{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T07:07:02Z","timestamp":1784790422863,"version":"3.55.0"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,22]]},"DOI":"10.7759\/cureus.113199","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T06:29:27Z","timestamp":1784788167000},"source":"Crossref","is-referenced-by-count":0,"title":["Balanced Crystalloids Versus Normal Saline for Fluid Resuscitation in Patients With Diabetic Ketoacidosis: A Systematic Review"],"prefix":"10.7759","author":[{"given":"Mohamed Ahmed","family":"Hamed","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Talal Abdullah Ahmed","family":"Alnajjar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziyad Daifallah","family":"Alsubhi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1177\/15209156251390828","article-title":"Global Burden of diabetic ketoacidosis","volume":"27","author":"Mohan V","year":"2025","unstructured":"Mohan V, Lee K. Global Burden of diabetic ketoacidosis. Diabetes Technol Ther. 2025, 27:S6-S13. 10.1177\/15209156251390828","journal-title":"Diabetes Technol Ther"},{"key":"ref2","article-title":"A structured diabetes self-management education and support (DSMES) intervention to reduce HbA1c levels in adults with type 2 diabetes","author":"Lubin T","year":"2026","unstructured":"Lubin T. A structured diabetes self-management education and support (DSMES) intervention to reduce HbA1c levels in adults with type 2 diabetes. St. Thomas University, Florida, USA; 2026."},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.2337\/dci24-0032","article-title":"Hyperglycemic crises in adults with diabetes: a consensus report","volume":"47","author":"Umpierrez GE","year":"2024","unstructured":"Umpierrez GE, Davis GM, ElSayed NA, et al.. Hyperglycemic crises in adults with diabetes: a consensus report. Diabetes Care. 2024, 47:1257-75. 10.2337\/dci24-0032","journal-title":"Diabetes Care"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.24596","article-title":"Clinical effects of balanced crystalloids vs saline in adults with diabetic ketoacidosis: a subgroup analysis of cluster randomized clinical trials","volume":"3","author":"Self WH","year":"2020","unstructured":"Self WH, Evans CS, Jenkins CA, et al.. Clinical effects of balanced crystalloids vs saline in adults with diabetic ketoacidosis: a subgroup analysis of cluster randomized clinical trials. JAMA Netw Open. 2020, 3:e2024596. 10.1001\/jamanetworkopen.2020.24596","journal-title":"JAMA Netw Open"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.3831","article-title":"Fluid resuscitation with balanced electrolyte solutions results\u00a0in faster resolution of diabetic ketoacidosis than with\u00a00.9% saline in adults - a systematic review and meta-analysis","volume":"40","author":"Szab\u00f3 GV","year":"2024","unstructured":"Szab\u00f3 GV, Szigetv\u00e1ry C, Turan C, et al.. Fluid resuscitation with balanced electrolyte solutions results\u00a0in faster resolution of diabetic ketoacidosis than with\u00a00.9% saline in adults - a systematic review and meta-analysis. Diabetes Metab Res Rev. 2024, 40:e3831. 10.1002\/dmrr.3831","journal-title":"Diabetes Metab Res Rev"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page MJ","year":"2021","unstructured":"Page MJ, McKenzie JE, Bossuyt PM, et al.. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Br Med J. 2021, 372:n71. 10.1136\/bmj.n71","journal-title":"Br Med J"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-016-0384-4","article-title":"Rayyan-a web and mobile app for systematic reviews","volume":"5","author":"Ouzzani M","year":"2016","unstructured":"Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan-a web and mobile app for systematic reviews. Syst Rev. 2016, 5:210. 10.1186\/s13643-016-0384-4","journal-title":"Syst Rev"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: a revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne JA","year":"2019","unstructured":"Sterne JA, Savovi\u0107 J, Page MJ, et al.. RoB 2: a revised tool for assessing risk of bias in randomised trials. Br Med J. 2019, 366:l4898. 10.1136\/bmj.l4898","journal-title":"Br Med J"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i4919","article-title":"ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions","volume":"355","author":"Sterne JA","year":"2016","unstructured":"Sterne JA, Hern\u00e1n MA, Reeves BC, et al.. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. Br Med J. 2016, 355:i4919. 10.1136\/bmj.i4919","journal-title":"Br Med J"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.4274\/tybd.galenos.2024.09821","article-title":"Which Crystaloid fluid should be used for the treatment of diabetic ketoacidosis: a retrospective cohort study","volume":"23","author":"Aslan M","year":"2025","unstructured":"Aslan M. Which Crystaloid fluid should be used for the treatment of diabetic ketoacidosis: a retrospective cohort study. Turk J Intensive Care. 2025, 23:53-60. 10.4274\/tybd.galenos.2024.09821","journal-title":"Turk J Intensive Care"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1177\/19322968241235941","article-title":"Evaluation of a protocol change promoting lactated Ringers over normal saline in the treatment of diabetic ketoacidosis","volume":"18","author":"Johnson J","year":"2024","unstructured":"Johnson J, Drincic A, Buddenhagen E, Nein K, Samson K, Langenhan T. Evaluation of a protocol change promoting lactated Ringers over normal saline in the treatment of diabetic ketoacidosis. J Diabetes Sci Technol. 2024, 18:549-55. 10.1177\/19322968241235941","journal-title":"J Diabetes Sci Technol"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1177\/10600280211063651","article-title":"Balanced crystalloid versus normal saline as resuscitative fluid in diabetic ketoacidosis","volume":"56","author":"Carrillo AR","year":"2022","unstructured":"Carrillo AR, Elwood K, Werth C, Mitchell J, Sarangarm P. Balanced crystalloid versus normal saline as resuscitative fluid in diabetic ketoacidosis. Ann Pharmacother. 2022, 56:998-1006. 10.1177\/10600280211063651","journal-title":"Ann Pharmacother"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1002\/phar.4600","article-title":"Lactated Ringer's versus normal saline in the management of acute diabetic ketoacidosis (RINSE-DKA)","volume":"44","author":"Jamison A","year":"2024","unstructured":"Jamison A, Mohamed A, Chedester C, Klindworth K, Hamarshi M, Sembroski E. Lactated Ringer's versus normal saline in the management of acute diabetic ketoacidosis (RINSE-DKA). Pharmacotherapy. 2024, 44:623-30. 10.1002\/phar.4600","journal-title":"Pharmacotherapy"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1186\/s40814-023-01356-5","article-title":"Balanced crystalloids (RInger's lactate) versus normal Saline in adults with diabetic Ketoacidosis in the Emergency Department (BRISK-ED): a protocol for a pilot randomized controlled trial","volume":"9","author":"Yan JW","year":"2023","unstructured":"Yan JW, Slim A, Van Aarsen K, et al.. Balanced crystalloids (RInger's lactate) versus normal Saline in adults with diabetic Ketoacidosis in the Emergency Department (BRISK-ED): a protocol for a pilot randomized controlled trial. Pilot Feasibility Stud. 2023, 9:121. 10.1186\/s40814-023-01356-5","journal-title":"Pilot Feasibility Stud"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hcae169","article-title":"Balanced crystalloid (Sterofundin) vs. normal saline for diabetic ketoacidosis: a prospective intervention trial with historical controls","volume":"118","author":"Bharti D","year":"2025","unstructured":"Bharti D, Selvam S, Sharma N, Dutta P, Pannu AK. Balanced crystalloid (Sterofundin) vs. normal saline for diabetic ketoacidosis: a prospective intervention trial with historical controls. QJM. 2025, 118:79-86. 10.1093\/qjmed\/hcae169","journal-title":"QJM"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1136\/bmjdrc-2024-004623","article-title":"0.9% Saline versus Ringer's lactate as initial fluid in children with diabetic ketoacidosis: a double-blind randomized controlled trial","volume":"13","author":"Agarwal A","year":"2025","unstructured":"Agarwal A, Jayashree M, Nallasamy K, Dayal D, Attri SV. 0.9% Saline versus Ringer's lactate as initial fluid in children with diabetic ketoacidosis: a double-blind randomized controlled trial. BMJ Open Diabetes Res Care. 2025, 13:e004623. 10.1136\/bmjdrc-2024-004623","journal-title":"BMJ Open Diabetes Res Care"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1007\/s12098-024-05240-9","article-title":"Normal saline versus Ringer's lactate for intravenous fluid therapy in children with diabetic ketoacidosis: a randomized controlled trial","volume":"92","author":"Singhal D","year":"2025","unstructured":"Singhal D, Gupta S, Kumar V. Normal saline versus Ringer's lactate for intravenous fluid therapy in children with diabetic ketoacidosis: a randomized controlled trial. Indian J Pediatr. 2025, 92:1181-7. 10.1007\/s12098-024-05240-9","journal-title":"Indian J Pediatr"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.5409\/wjcp.v15.i1.111304","article-title":"Balanced electrolyte solution vs isotonic saline in the resuscitation of children with diabetic ketoacidosis: a randomized controlled trial","volume":"15","author":"Sweety S","year":"2026","unstructured":"Sweety S, Panda S, Das RR. Balanced electrolyte solution vs isotonic saline in the resuscitation of children with diabetic ketoacidosis: a randomized controlled trial. World J Clin Pediatr. 2026, 15:111304. 10.5409\/wjcp.v15.i1.111304","journal-title":"World J Clin Pediatr"},{"key":"ref19","article-title":"Comparison of balanced crystalloids versus normal saline in patients with diabetic ketoacidosis: a meta-analysis of randomized controlled trials","volume":"21","author":"Liu Y","year":"2024","unstructured":"Liu Y, Zhang J, Xu X, Zou X. Comparison of balanced crystalloids versus normal saline in patients with diabetic ketoacidosis: a meta-analysis of randomized controlled trials. Front Endocrinol. 2024, 21:1367916.","journal-title":"Front Endocrinol"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1097\/CCE.0000000000000613","article-title":"Saline compared to balanced crystalloid in patients with diabetic ketoacidosis: a systematic review and meta-analysis of randomized controlled trials","volume":"4","author":"Alghamdi NA","year":"2022","unstructured":"Alghamdi NA, Major P, Chaudhuri D, et al.. Saline compared to balanced crystalloid in patients with diabetic ketoacidosis: a systematic review and meta-analysis of randomized controlled trials. Crit Care Explor. 2022, 4:e0613. 10.1097\/CCE.0000000000000613","journal-title":"Crit Care Explor"},{"key":"ref21","article-title":"Battle of fluids: comparing normal saline and lactated Ringer's in diabetic ketoacidosis management-a systematic review and meta-analysis","volume":"8","author":"Shaban EE","year":"2025","unstructured":"Shaban EE, Elmelliti H, Ponappan B, et al.. Battle of fluids: comparing normal saline and lactated Ringer's in diabetic ketoacidosis management-a systematic review and meta-analysis. J Emerg Med Trauma Acute Care. 2025, 8:2025.","journal-title":"J Emerg Med Trauma Acute Care"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.77739","article-title":"Revisiting diabetic ketoacidosis (DKA) fluid management: should normal saline be used?","volume":"17","author":"Messina N","year":"2025","unstructured":"Messina N, Anderson Z, Saravis L, Jimenez G, Plowman K, Harrington D. Revisiting diabetic ketoacidosis (DKA) fluid management: should normal saline be used?. Cureus. 2025, 17:e77739. 10.7759\/cureus.77739","journal-title":"Cureus"},{"key":"ref23","article-title":"Evaluating the effectiveness of modern treatment protocols in managing diabetic ketoacidosis in intensive care units: a systematic review","volume":"21","author":"Ismail MA","year":"2025","unstructured":"Ismail MA, Bali ME, Alturaifi AH, et al.. Evaluating the effectiveness of modern treatment protocols in managing diabetic ketoacidosis in intensive care units: a systematic review. Rev Diabet Stud. 2025, 21:475-85.","journal-title":"Rev Diabet Stud"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.15441\/ceem.24.209","article-title":"Is Plasmalyte beneficial in the resuscitation of diabetic ketoacidosis patients? A narrative review","volume":"12","author":"Sudha RK","year":"2025","unstructured":"Sudha RK, Moin K, Hameed FA, Chatha HA. Is Plasmalyte beneficial in the resuscitation of diabetic ketoacidosis patients? A narrative review. Clin Exp Emerg Med. 2025, 12:104-9. 10.15441\/ceem.24.209","journal-title":"Clin Exp Emerg Med"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1711584","article-title":"Balanced crystalloids versus saline in critically ill adults","volume":"378","author":"Semler MW","year":"2018","unstructured":"Semler MW, Self WH, Wanderer JP, et al.. Balanced crystalloids versus saline in critically ill adults. N Engl J Med. 2018, 378:829-39. 10.1056\/NEJMoa1711584","journal-title":"N Engl J Med"},{"key":"ref26","article-title":"Buffered salt solution versus 0.9% sodium chloride as fluid therapy for patients presenting with moderate to severe diabetic ketoacidosis: study protocol for a Phase-3 cluster-crossover, blinded, randomised, controlled trial","volume":"27","author":"Ramanan M","year":"2025","unstructured":"Ramanan M, Rajbhandari D, Koch, et al.. Buffered salt solution versus 0.9% sodium chloride as fluid therapy for patients presenting with moderate to severe diabetic ketoacidosis: study protocol for a Phase-3 cluster-crossover, blinded, randomised, controlled trial. Crit Care Resusc. 2025, 27:100104.","journal-title":"Crit Care Resusc"},{"key":"ref27","article-title":"Diabetic ketoacidosis fluid management in children: systematic review and meta-analyses","volume":"107","author":"Hamud AA","year":"20221","unstructured":"Hamud AA, Mudawi K, Shamekh A, Kadri A, Powell C, Abdelgadir. Diabetic ketoacidosis fluid management in children: systematic review and meta-analyses. Arch Dis Child. 20221, 107:1023-8.","journal-title":"Arch Dis Child"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1097\/MCO.0000000000001005","article-title":"Fluid therapy in diabetic ketoacidosis","volume":"27","author":"Ramanan M","year":"2024","unstructured":"Ramanan M, Delaney A, Venkatesh B. Fluid therapy in diabetic ketoacidosis. Curr Opin Clin Nutr Metab Care. 2024, 27:178-83. 10.1097\/MCO.0000000000001005","journal-title":"Curr Opin Clin Nutr Metab Care"}],"container-title":["Cureus"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cureus.com\/articles\/506389-balanced-crystalloids-versus-normal-saline-for-fluid-resuscitation-in-patients-with-diabetic-ketoacidosis-a-systematic-review","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T06:29:28Z","timestamp":1784788168000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cureus.com\/articles\/506389-balanced-crystalloids-versus-normal-saline-for-fluid-resuscitation-in-patients-with-diabetic-ketoacidosis-a-systematic-review"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,22]]},"references-count":28,"URL":"https:\/\/doi.org\/10.7759\/cureus.113199","relation":{},"ISSN":["2168-8184"],"issn-type":[{"value":"2168-8184","type":"print"}],"subject":[],"published":{"date-parts":[[2026,7,22]]}}}