Balanced crystalloids vs. 0.9% saline in pediatric diabetic ketoacidosis: a systematic review and meta-analysis of randomized controlled trials - Report - MDSpire

Balanced crystalloids vs. 0.9% saline in pediatric diabetic ketoacidosis: a systematic review and meta-analysis of randomized controlled trials

  • By

  • Zeid Alkhairi

  • Charlie Kajo

  • Abdolaziz A. Zadeh

  • Dawood Khaja

  • Mohammad Alqaryuti

  • Nada K. Alsaleh

  • Rataj Alibrahim

  • Fahad Almuhannadi

  • Suod Al Hammad

  • Fatima Alqanea

  • Abdullatif Alfehaid

  • July 9, 2026

  • 0 min

Share

Clinical Report: Comparison of Balanced Crystalloids and 0.9% Saline in Pediatric DKA

Overview

This systematic review and meta-analysis evaluated the efficacy of balanced crystalloids versus 0.9% saline for fluid resuscitation in pediatric diabetic ketoacidosis (DKA).

Background

Fluid resuscitation is critical in managing pediatric DKA, a serious complication of diabetes. Traditionally, 0.9% saline has been used, but concerns about its chloride content and potential adverse effects have prompted interest in balanced crystalloids.

Data Highlights

OutcomeBalanced Crystalloids0.9% Saline
Time to DKA Resolution−1.60 h (95% CI: −3.07 to −0.13)Reference
New-Onset AKIRR: 0.55 (95% CI: 0.17–1.82; p = 0.325)Reference
HypokalemiaRR: 0.66 (95% CI: 0.46–0.93)Reference
HyperchloremiaRR: 0.40 (95% CI: 0.21–0.78)Reference

Key Findings

  • A modest decrease in time to DKA resolution was observed with balanced crystalloids.
  • No significant effect on new-onset acute kidney injury was determined due to statistical uncertainty.
  • Balanced crystalloids were associated with a lower incidence of hypokalemia.
  • Balanced crystalloids also showed a reduced incidence of hyperchloremia.

Clinical Implications

Clinicians should remain cautious when selecting fluids for pediatric DKA management. Ongoing monitoring for complications and further research are necessary.

Conclusion

Further research is needed to establish the role of balanced crystalloids in pediatric DKA management.

Related Resources & Content

  1. Frontiers, Frontiers in Pediatrics, 2026 -- Balanced crystalloids vs. 0.9% saline in pediatric diabetic ketoacidosis: a systematic review and meta-analysis of randomized controlled trials
  2. American Diabetes Association, Diabetes Care, 2026 -- Diabetes Care in the Hospital: Standards of Care in Diabetes
  3. New England Journal of Medicine, Clinical Trial of Fluid Infusion Rates for Pediatric Diabetic Ketoacidosis
  4. Approaches to Intravenous Fluid Resuscitation in Trauma Cases
  5. Intensive Care Medicine — Fluid Maintenance and Creep Contribute to Greater Sodium and Chloride Load Compared to Resuscitation Fluids in Critically Ill Patients: A Retrospective Analysis in a Tertiary Mixed ICU Setting
  6. Intensive Care Medicine — Review of Key Developments in Intensive Care Medicine for 2011: Focus on Cardiovascular Issues, Infections, Pneumonia, Sepsis, Critical Care Organization and Outcomes, Education, Ultrasonography, Metabolism, and Coagulation
  7. Intensive Care Medicine — Strategies for Preventing Acute Kidney Injury and Preserving Renal Function in Intensive Care Settings: A 2017 Update
  8. Approaches to Intravenous Fluid Resuscitation in Trauma Cases
  9. Fluid Maintenance and Creep in Critically Ill Patients
  10. Review of Key Developments in Intensive Care Medicine
  11. 16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2026 | Diabetes Care | American Diabetes Association
  12. Clinical Trial of Fluid Infusion Rates for Pediatric Diabetic Ketoacidosis | New England Journal of Medicine
  13. Frontiers | Balanced crystalloids vs. 0.9% saline in pediatric diabetic ketoacidosis: a systematic review and meta-analysis of randomized controlled trials

Original Source(s)

Balanced crystalloids vs. 0.9% saline in pediatric diabetic ketoacidosis: a systematic review and meta-analysis of randomized controlled trials

  • by Zeid Alkhairi, Charlie Kajo, Abdolaziz A. Zadeh, Dawood Khaja, Mohammad Alqaryuti, Nada K. Alsaleh, Rataj Alibrahim, Fahad Almuhannadi, Suod Al Hammad, Fatima Alqanea, Abdullatif Alfehaid

  • July 9, 2026

Related Content

The clinical value of pediatric laparoscopic surgery using umbilical S-shaped incision

Implementing exercise interventions in pediatric oncology: an expert consensus framework from the FORTEe project

Memory-focused therapy: an integrated intervention to reduce trauma symptoms, maladaptive cognitive processes, and emotional distress in Afghan youth