Revisiting Diabetic Ketoacidosis (DKA) Fluid Management: Should Normal Saline Be Used?

Area of Science:

• Endocrinology
• Critical Care Medicine
• Nephrology

Background:

• Diabetic ketoacidosis (DKA) is a severe diabetes complication requiring intensive care.
• Fluid resuscitation is key in DKA management, with normal saline (NS) traditionally used.
• Concerns exist that large NS volumes may cause hyperchloremic acidosis and adverse outcomes.

Purpose of the Study:

• To assess if large-volume NS resuscitation in DKA patients correlates with prolonged ICU length of stay (LOS).
• To evaluate the association between NS volume and increased insulin infusion duration post-DKA resolution.
• To determine if high NS volumes increase the incidence of non-anion gap metabolic acidosis after DKA resolution.

Main Methods:

• Retrospective, single-center observational study of 109 DKA patients.
• Patients categorized by NS volume received: 0L, 1L, 2L, and ≥3L.
• Statistical analysis (ANOVA, t-tests, chi-square) compared ICU LOS, overall LOS, insulin duration, and acidosis incidence.

Main Results:

• Patients receiving 2L (p=0.0249) and ≥3L (p=0.00065) of NS had significantly longer ICU LOS than the 0L group.
• A ≥3L NS volume was linked to a significantly longer insulin infusion duration (p=0.0101).
• Receiving ≥2L NS significantly increased non-anion gap acidosis incidence (p=0.0000).

Conclusions:

• Large-volume NS resuscitation in DKA is associated with prolonged ICU stay, extended insulin use, and higher rates of non-anion gap metabolic acidosis.
• Findings suggest balanced crystalloids like lactated Ringer's may be preferable for DKA resuscitation.
• Further prospective studies are recommended to confirm these results and refine DKA fluid management protocols.