Balanced crystalloids for fluid resuscitation in diabetic ketoacidosis in place of saline

Background: Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes. With rising mortality from the condition and associated healthcare costs, prompt prehospital recognition and optimum management are necessary to improve patient outcomes. Upon recognition of DKA, it is recommended that fluid resuscitation be started immediately with sodium chloride 0.9%. Aim: To examine the literature investigating the effectiveness of balanced crystalloids and saline in the management of DKA and the potential implications of this for practice. Methodology: A literature review was undertaken using five databases and the evidence was critically appraised. Themes were developed to explore the results. Results: The three included studies indicated that balanced crystalloids may lead to faster DKA resolution than saline. Better electrolyte outcomes were also noted in the balanced crystalloid group, with no increased adverse effects observed. Conclusion: The adoption of balanced crystalloids in the prehospital setting has the potential to improve patient outcomes. Further research and clinical trials are required to validate these findings and inform guideline revisions.