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Clinical Effects of Balanced Crystalloids vs Saline in Adults with Diabetic Ketoacidosis

Self WH, Evans CS, Jenkins CA, et al. JAMA Network Open. 2020;3(11):e2024596. doi:10.1001/jamanetworkopen.2020.24596.
      Intravenous fluid (IVF) administration is a key component in the treatment of diabetic ketoacidosis (DKA). Normal saline is currently the primary fluid recommended by clinical practice guidelines for the treatment of DKA; however, it has been shown to cause a hyperchloremic metabolic acidosis due to its high chloride concentration when compared to human plasma. Balanced crystalloid solutions, like Lactated Ringer’s (LR) and Plasma-Lyte A (Baxter Inc), do not cause a metabolic acidosis as their chloride concentrations are similar to human plasma. Considering this information, treatment with balanced crystalloids may lead to faster resolution of DKA. The objective of this study was to compare the clinical effects of balanced crystalloid with those of saline for the acute treatment of DKA.
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