Choice of Intravenous Fluid for Resuscitation in Diabetic Ketoacidosis

This clinical decision article explores the debate over intravenous fluid choice for resuscitation in diabetic ketoacidosis (DKA). A case vignette presents a 34-year-old woman with DKA, hypovolemia, and metabolic derangements. Two experts argue for opposing approaches:

1. Balanced crystalloids (e.g., lactated Ringer’s): Advocates highlight faster DKA resolution, reduced hyperchloremic acidosis risk, and nuanced electrolyte management, despite limited robust trial data.

2. Isotonic saline (0.9% normal saline): Proponents emphasize guideline adherence, effective sodium/chloride replenishment, and minimal renal risk during short resuscitation phases, citing systematic reviews and large trials showing no significant outcome differences.
   The article underscores the need for individualized care, ongoing research, and frequent reassessment of acid-base and electrolyte status.

This clinical decision article explores the debate over intravenous fluid choice for resuscitation in diabetic ketoacidosis (DKA). A case vignette presents a 34-year-old woman with DKA, hypovolemia, and metabolic derangements. Two experts argue for opposing approaches:

1. Balanced crystalloids (e.g., lactated Ringer’s): Advocates highlight faster DKA resolution, reduced hyperchloremic acidosis risk, and nuanced electrolyte management, despite limited robust trial data.

2. Isotonic saline (0.9% normal saline): Proponents emphasize guideline adherence, effective sodium/chloride replenishment, and minimal renal risk during short resuscitation phases, citing systematic reviews and large trials showing no significant outcome differences.
   The article underscores the need for individualized care, ongoing research, and frequent reassessment of acid-base and electrolyte status.