Choice of Fluid in the Acute Management of Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a potentially life-threatening complication which occurs mainly in patients with type 1 diabetes, but it is also not uncommon in type 2 diabetics. In the United States, it accounts for 30 admissions per 1000 diabetic patients every year, with a mortality of 1-5% [1]. DKA is characterized by high anion gap metabolic ketoacidosis, hyperglycemia and ketonuria. Stress events including infection, non-compliance to medications are triggers of DKA. Fluid administration to address hypovolemia and ensure adequate kidney perfusion, along with insulin and electrolytes replacement are cornerstones of management. Currently, in terms of fluid resuscitation, the Joint British Diabetes Society (JBDS) guideline and the American Diabetes Association (ADA) recommends the use of normal saline (NS) [2, 3]. The choice of fluid is debatable as no definite superiority of one type of fluid over another is clearly demonstrated. However, studies have shown improvement in certain clinical outcomes, for instance, quicker resolution of DKA when balanced crystalloid fluids are used [4]. This essay mainly reviews the currently available evidence on the differences in clinical outcomes with respect to choice of crystalloids in treating DKA patients.