Which Crystaloid Fluid Should be Used for the Treatment of Diabetic Ketoacidosis: A Retrospective Cohort Study

Objective: We aimed to compare the advantages and disadvantages of saline (0.9% NACI) and balanced crystalloid (Isolene or Lactated ringer) solutions in patients with diabetic ketoacidosis (DKA). Materials and Methods: The study was conducted retrospectively on 80 patients (saline=31, balanced=49) with moderate-to-severe DKA among 129 patients with DKA who were admitted to the adult intensive care unit (ICU) between 2013 and 2023. Results: The DKA resolution times were similar in the saline and balance groups [12 h (6-16), 9 h (7-12), p=0539]. Statistically, the blood chlorine level after DKA resolution was higher in the saline group than in the balanced group (115 +/- 5.5, 110.8 +/- 4.4, p<0.001) and the anion gap value was lower [5.9 (3.9-10.6), 9.7 (7.0-12.0), p=0.005]. The blood potassium level after DKA solution was lower than normal in the saline group [3.4(3.1-3.6), 3.6(3.2-4.0), p=0.088]. There were no statistically significant differences between the saline and balanced groups in terms of 1-month mortality rates [0(0), 2(4.1), p=0.524], need for renal replacement therapy [1(3.2), 2(4.1), p=1.000], and ICU stay hours [46 (32-70), 44 (36-68), p=0.961]. Conclusion: The choice of saline or balanced crystalloid solution as the initial resuscitation fluid has no effect on DKA resolution time, mortality rate, or ICU length of stay. However, balanced electrolyte solutions have a lower side effect profile.