A Comparative Effectiveness of Intravenous Fluids and Insulin Regimens in the Acute Management of Diabetic Ketoacidosis (DKA) and Hypoglycemia: A Systematic Review
Bibliographic record
Abstract
Diabetic ketoacidosis (DKA) and hypoglycemia are acute metabolic emergencies requiring prompt and effective management in both adult and pediatric populations. Despite established protocols, variability in intravenous fluid and insulin regimens persists, necessitating a comprehensive evaluation of their comparative effectiveness across age groups. This systematic review aims to synthesize evidence on the efficacy and safety of different fluid and insulin strategies in managing DKA and hypoglycemia in diverse patient populations. Following PRISMA 2020 guidelines, a systematic search was conducted across PubMed, Embase, Web of Science, and Scopus. Nine studies (five randomized controlled trials (RCTs) and four cohort studies) were included after screening 227 records. Risk of bias was assessed using Cochrane RoB 2 for RCTs and the Newcastle-Ottawa Scale for cohort studies. Data were synthesized narratively due to clinical heterogeneity. Early subcutaneous insulin glargine with intravenous insulin reduced DKA resolution time (9.89 ± 3.81 vs. 12.73 ± 5.37 hours; p = 0.022) and hospital stay (4.75 vs. 15.25 days; p = 0.024) compared to intravenous insulin alone. Low-dose insulin (0.05 unit/kg/hour) in pediatric DKA showed comparable efficacy to the standard dose (0.1 unit/kg/hour), with fewer hypoglycemia (3.3% vs. 13.3%) and hypokalemia events (30% vs. 43.3%). Plasmalyte-148 accelerated metabolic acidosis resolution vs. sodium chloride (69% vs. 36% at 24 hours; p = 0.002). For hypoglycemia, 10% and 50% dextrose had similar efficacy, but 50% dextrose required higher doses and caused elevated post-treatment glucose (151.9 vs. 124.6 mg/dL; p = 0.001). Subcutaneous insulin protocols, low-dose insulin infusions, and balanced crystalloids optimize DKA management, while lower dextrose concentrations may suffice for hypoglycemia. Future research should prioritize multicenter RCTs to validate these findings.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
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 | 0.008 | 0.035 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.013 | 0.013 |
| Bibliometrics | 0.009 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| 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".