Choice of Intravenous Fluid for Resuscitation in Diabetic Ketoacidosis

This clinical decisions article examines optimal fluid resuscitation strategies in patients with diabetic ketoacidosis (DKA), using a case vignette of a 34-year-old woman with type 1 diabetes presenting with DKA. Two experts present opposing viewpoints: one advocates for balanced crystalloid fluids, such as lactated Ringer’s solution, citing potential benefits in reducing hyperchloremic metabolic acidosis and enhancing acid–base recovery. The other supports isotonic saline, aligned with current guidelines and emphasizing the electrolyte replacement and clinical familiarity of saline. The article highlights the ongoing debate, referencing physiologic considerations and recent studies, while emphasizing the need for more robust clinical trial data to guide evidence-based recommendations.

This clinical decisions article examines optimal fluid resuscitation strategies in patients with diabetic ketoacidosis (DKA), using a case vignette of a 34-year-old woman with type 1 diabetes presenting with DKA. Two experts present opposing viewpoints: one advocates for balanced crystalloid fluids, such as lactated Ringer’s solution, citing potential benefits in reducing hyperchloremic metabolic acidosis and enhancing acid–base recovery. The other supports isotonic saline, aligned with current guidelines and emphasizing the electrolyte replacement and clinical familiarity of saline. The article highlights the ongoing debate, referencing physiologic considerations and recent studies, while emphasizing the need for more robust clinical trial data to guide evidence-based recommendations.