Battle of fluids: Comparing normal saline and lactated ringer’s in diabetic ketoacidosis management—A systematic review and meta-analysis
Bibliographic record
Abstract
Background: Current guidelines recommend the use of normal saline (NS) as the preferred resuscitative fluid in the treatment of diabetic ketoacidosis (DKA). However, due to the development of hyperchloremic metabolic acidosis when using NS, balanced crystalloids such as lactated Ringer’s solution (LRS) and plasma-lyte have been proposed as alternative treatments. Therefore, the current meta-analysis investigated the efficacy and safety of NS compared to LRS in managing DKA. Methods: A comprehensive literature search directly comparing NS to LRS was conducted on PubMed, MEDLINE, Web of Science, and Google Scholar databases. This search was limited to articles authored in English; however, no time limitation was provided. A random-effects model was used to summarize the mean differences (MD) and their corresponding 95% confidence intervals (CI). Moreover, methodological quality appraisal was performed using Cochrane’s Risk of Bias tool and the Newcastle–Ottawa Scale. Results: A total of six studies enrolling 50,330 patients with DKA were included. A pooled MD indicated no significant difference in the time to DKA resolution between the NS and LRS groups (MD: 1.12; 95% CI: −0.69 to 2.93; p = 0.23). Similarly, no significant difference was observed between the two groups in terms of the total volume of fluids administered (MD: 436.57; 95% CI: −280.92 to 1154.06; p = 0.23) and length of hospitalization (MD: −0.01; 95% CI: −0.53 to 0.50; p = 0.96). However, the pooled data indicated that the duration of intensive care unit (ICU) stay was significantly shorter in the LRS group (MD: 4.79; 95% CI: 1.98 to 7.59; p = 0.0008). Similarly, patients who received LRS showed significantly higher levels of post-resuscitation bicarbonate and lower levels of post-resuscitation chloride than those who received NS (MD: −1.22; 95% CI: −1.67 to −0.77; p < 0.00001 and MD: 4.74; 95% CI: −0.23 to 9.25; p = 0.04, respectively). Conclusion: LRS was as effective as NS in resolving DKA. Therefore, LRS can be considered as an alternative treatment option for DKA.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.015 | 0.033 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.023 | 0.040 |
| Bibliometrics | 0.007 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".