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      <abstractText>Fluid resuscitation during diabetic ketoacidosis (DKA) is most frequently performed with 0.9% saline despite its high chloride and sodium concentration. Balanced Electrolyte Solutions (BES) may prove a more physiological alternative, but convincing evidence is missing. We aimed to compare the efficacy of 0.9% saline to BES in DKA management. MEDLINE, Cochrane Library, and Embase databases were searched for relevant studies using predefined keywords (from inception to 27 November 2021). Relevant studies were those in which 0.9% saline (Saline-group) was compared to BES (BES-group) in adults admitted with DKA. Two reviewers independently extracted data and assessed the risk of bias. The primary outcome was time to DKA resolution (defined by each study individually), while the main secondary outcomes were changes in laboratory values, duration of insulin infusion, and mortality. We included seven randomized controlled trials and three observational studies with 1006 participants. The primary outcome was reported for 316 patients, and we found that BES resolves DKA faster than 0.9% saline with a mean difference (MD) of -5.36 [95% CI: -10.46, -0.26] hours. Post-resuscitation chloride (MD: -4.26 [-6.97, -1.54] mmoL/L) and sodium (MD: -1.38 [-2.14, -0.62] mmoL/L) levels were significantly lower. In contrast, levels of post-resuscitation bicarbonate (MD: 1.82 [0.75, 2.89] mmoL/L) were significantly elevated in the BES-group compared to the Saline-group. There was no statistically significant difference between the groups regarding the duration of parenteral insulin administration (MD: 0.16 [-3.03, 3.35] hours) or mortality (OR: -0.67 [0.12, 3.68]). Studies showed some concern or a high risk of bias, and the level of evidence for most outcomes was low. This meta-analysis indicates that the use of BES resolves DKA faster than 0.9% saline. Therefore, DKA guidelines should consider BES instead of 0.9% saline as the first choice during fluid resuscitation.</abstractText>
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Orvostudomány, egészségtudomány&lt;/span&gt;) &lt;/a&gt; &lt;/span&gt; &lt;span class=&quot;author-affil&quot;&gt;&lt;span title=&quot;Semmelweis Egyetem&quot;&gt;SE&lt;/span&gt;/&lt;span title=&quot;Általános Orvostudományi Kar&quot;&gt;AOK&lt;/span&gt;/&lt;span title=&quot;Klinikum&quot;&gt;K&lt;/span&gt;/Aneszteziológiai és Intenzív Terápiás Klinika; &lt;span title=&quot;Semmelweis Egyetem&quot;&gt;SE&lt;/span&gt;/&lt;span title=&quot;Központi Szervezeti Egységek (beleértve az Egyéb Szervezeti Egységeket)&quot;&gt;KSZE&lt;/span&gt;/Transzlációs Medicina Központ&lt;/span&gt; ;&amp;nbsp;&amp;nbsp;&amp;nbsp; &lt;span class=&quot;author-name&quot; mtid=&quot;10077662&quot;&gt;&lt;a href=&quot;/gui2/?type=authors&amp;mode=browse&amp;sel=10077662&quot; target=&quot;_blank&quot;&gt;Turan Caner (&lt;span class=&quot;authorship-author-name&quot;&gt;Turan Caner&lt;/span&gt; &lt;span class=&quot;authorAux-mtmt&quot;&gt; Anesthesia and Intensive Care&lt;/span&gt;) &lt;/a&gt; &lt;/span&gt; &lt;span class=&quot;author-affil&quot;&gt;&lt;span title=&quot;Semmelweis Egyetem&quot;&gt;SE&lt;/span&gt;/&lt;span title=&quot;Általános Orvostudományi Kar&quot;&gt;AOK&lt;/span&gt;/&lt;span title=&quot;Klinikum&quot;&gt;K&lt;/span&gt;/Aneszteziológiai és Intenzív Terápiás Klinika; &lt;span title=&quot;Semmelweis Egyetem&quot;&gt;SE&lt;/span&gt;/&lt;span title=&quot;Központi Szervezeti Egységek (beleértve az Egyéb Szervezeti Egységeket)&quot;&gt;KSZE&lt;/span&gt;/Transzlációs Medicina Központ&lt;/span&gt; ;&amp;nbsp;&amp;nbsp;&amp;nbsp; &lt;span class=&quot;author-name&quot; mtid=&quot;10086474&quot;&gt;&lt;a href=&quot;/gui2/?type=authors&amp;mode=browse&amp;sel=10086474&quot; target=&quot;_blank&quot;&gt;Engh Marie Anne (&lt;span class=&quot;authorship-author-name&quot;&gt;Engh Marie Anne&lt;/span&gt; &lt;span class=&quot;authorAux-mtmt&quot;&gt; Orvostudomány, egészségtudomány&lt;/span&gt;) &lt;/a&gt; &lt;/span&gt; &lt;span class=&quot;author-affil&quot;&gt;&lt;span title=&quot;Semmelweis Egyetem&quot;&gt;SE&lt;/span&gt;/&lt;span title=&quot;Központi Szervezeti Egységek (beleértve az Egyéb Szervezeti Egységeket)&quot;&gt;KSZE&lt;/span&gt;/Transzlációs Medicina Központ&lt;/span&gt; ;&amp;nbsp;&amp;nbsp;&amp;nbsp; &lt;span class=&quot;author-name&quot; mtid=&quot;10025796&quot;&gt;&lt;a href=&quot;/gui2/?type=authors&amp;mode=browse&amp;sel=10025796&quot; target=&quot;_blank&quot;&gt;Terebessy Tamás (&lt;span class=&quot;authorship-author-name&quot;&gt;Terebessy Tamás&lt;/span&gt; &lt;span class=&quot;authorAux-mtmt&quot;&gt; ortopédia&lt;/span&gt;) &lt;/a&gt; &lt;/span&gt; &lt;span class=&quot;author-affil&quot;&gt;&lt;span title=&quot;Semmelweis Egyetem&quot;&gt;SE&lt;/span&gt;/&lt;span title=&quot;Általános Orvostudományi Kar&quot;&gt;AOK&lt;/span&gt;/&lt;span title=&quot;Klinikum&quot;&gt;K&lt;/span&gt;/Ortopédiai Klinika; &lt;span title=&quot;Semmelweis Egyetem&quot;&gt;SE&lt;/span&gt;/&lt;span title=&quot;Központi Szervezeti Egységek (beleértve az Egyéb Szervezeti Egységeket)&quot;&gt;KSZE&lt;/span&gt;/Transzlációs Medicina Központ&lt;/span&gt; ;&amp;nbsp;&amp;nbsp;&amp;nbsp; &lt;span class=&quot;author-name&quot; &gt;Fazekas Alíz &lt;/span&gt; ;&amp;nbsp;&amp;nbsp;&amp;nbsp; &lt;span class=&quot;author-name&quot; mtid=&quot;10015357&quot;&gt;&lt;a href=&quot;/gui2/?type=authors&amp;mode=browse&amp;sel=10015357&quot; target=&quot;_blank&quot;&gt;Farkas Nelli (&lt;span class=&quot;authorship-author-name&quot;&gt;Borbásné Farkas Kornélia&lt;/span&gt; &lt;span class=&quot;authorAux-mtmt&quot;&gt; Membránbiokémia, biostatisztika&lt;/span&gt;) &lt;/a&gt; &lt;/span&gt; &lt;span class=&quot;author-affil&quot;&gt;&lt;span title=&quot;Pécsi Tudományegyetem&quot;&gt;PTE&lt;/span&gt;/&lt;span title=&quot;Általános Orvostudományi Kar&quot;&gt;ÁOK&lt;/span&gt;/Bioanalitikai Intézet&lt;/span&gt; ;&amp;nbsp;&amp;nbsp;&amp;nbsp; &lt;span class=&quot;author-name&quot; mtid=&quot;10002629&quot;&gt;&lt;a href=&quot;/gui2/?type=authors&amp;mode=browse&amp;sel=10002629&quot; target=&quot;_blank&quot;&gt;Hegyi Péter (&lt;span class=&quot;authorship-author-name&quot;&gt;Hegyi Péter&lt;/span&gt; &lt;span class=&quot;authorAux-mtmt&quot;&gt; Gasztroenterológia&lt;/span&gt;) &lt;/a&gt; &lt;/span&gt; &lt;span class=&quot;author-affil&quot;&gt;&lt;span title=&quot;Semmelweis Egyetem&quot;&gt;SE&lt;/span&gt;/&lt;span title=&quot;Központi Szervezeti Egységek (beleértve az Egyéb Szervezeti Egységeket)&quot;&gt;KSZE&lt;/span&gt;/Transzlációs Medicina Központ; &lt;span title=&quot;Semmelweis Egyetem&quot;&gt;SE&lt;/span&gt;/&lt;span title=&quot;Általános Orvostudományi Kar&quot;&gt;AOK&lt;/span&gt;/&lt;span title=&quot;Klinikum&quot;&gt;K&lt;/span&gt;/Pankreász Betegségek Intézete&lt;/span&gt; ;&amp;nbsp;&amp;nbsp;&amp;nbsp; &lt;span class=&quot;author-name&quot; mtid=&quot;10001298&quot;&gt;&lt;a href=&quot;/gui2/?type=authors&amp;mode=browse&amp;sel=10001298&quot; target=&quot;_blank&quot;&gt;Molnár Zsolt ✉ (&lt;span class=&quot;authorship-author-name&quot;&gt;Molnár Zsolt&lt;/span&gt; &lt;span class=&quot;authorAux-mtmt&quot;&gt; Klinikai orvostudományok - aneszteziológia és i...&lt;/span&gt;) &lt;/a&gt; &lt;/span&gt; &lt;span class=&quot;author-affil&quot;&gt;&lt;span title=&quot;Semmelweis Egyetem&quot;&gt;SE&lt;/span&gt;/&lt;span title=&quot;Általános Orvostudományi Kar&quot;&gt;AOK&lt;/span&gt;/&lt;span title=&quot;Klinikum&quot;&gt;K&lt;/span&gt;/Aneszteziológiai és Intenzív Terápiás Klinika; &lt;span title=&quot;Semmelweis Egyetem&quot;&gt;SE&lt;/span&gt;/&lt;span title=&quot;Központi Szervezeti Egységek (beleértve az Egyéb Szervezeti Egységeket)&quot;&gt;KSZE&lt;/span&gt;/Transzlációs Medicina Központ&lt;/span&gt; &lt;/div&gt; &lt;/div&gt; &lt;div class=&quot;title&quot;&gt;&lt;a href=&quot;/gui2/?mode=browse&amp;params=publication;35077014&quot; target=&quot;_blank&quot;&gt;Fluid resuscitation with balanced electrolyte solutions results in faster resolution of diabetic ketoacidosis than with 0.9% saline in adults - A systematic review and meta-analysis&lt;/a&gt;&lt;/div&gt; &lt;div&gt; &lt;span class=&quot;journal-title&quot;&gt;DIABETES-METABOLISM RESEARCH AND REVIEWS&lt;/span&gt; &lt;span class=&quot;journal-issn&quot;&gt;(&lt;a target=&quot;_blank&quot; href=&quot;https://portal.issn.org/resource/ISSN/1520-7552&quot;&gt;1520-7552&lt;/a&gt; &lt;a target=&quot;_blank&quot; href=&quot;https://portal.issn.org/resource/ISSN/1520-7560&quot;&gt;1520-7560&lt;/a&gt;)&lt;/span&gt;: &lt;span class=&quot;journal-volume&quot;&gt;40&lt;/span&gt; &lt;span class=&quot;journal-issue&quot;&gt;5&lt;/span&gt; &lt;span class=&quot;page&quot;&gt; Paper e3831. 13 p. &lt;/span&gt; &lt;span class=&quot;year&quot;&gt;(2024)&lt;/span&gt; &lt;/div&gt; &lt;div class=&quot;pub-footer&quot;&gt;  &lt;span class=&quot;language&quot; xmlns=&quot;http://www.w3.org/1999/html&quot;&gt;Nyelv: Angol | &lt;/span&gt; &lt;span class=&quot;identifiers&quot;&gt; &lt;span class=&quot;id identifier oa_GOLD&quot; title=&quot; Gold &quot;&gt; &lt;a style=&quot;color:blue&quot; title=&quot;10.1002/dmrr.3831&quot; target=&quot;_blank&quot; href=&quot;https://doi.org/10.1002/dmrr.3831&quot;&gt; DOI &lt;/a&gt; &lt;/span&gt; &lt;span class=&quot;id identifier oa_none&quot; title=&quot;none&quot;&gt; &lt;a style=&quot;color:blue&quot; title=&quot;001253046800001&quot; target=&quot;_blank&quot; href=&quot;https://www.webofscience.com/wos/woscc/full-record/001253046800001&quot;&gt; WoS &lt;/a&gt; &lt;/span&gt; &lt;span class=&quot;id identifier oa_none&quot; title=&quot;none&quot;&gt; &lt;a style=&quot;color:blue&quot; title=&quot;85196632801&quot; target=&quot;_blank&quot; href=&quot;http://www.scopus.com/record/display.url?origin=inward&amp;eid=2-s2.0-85196632801&quot;&gt; Scopus &lt;/a&gt; &lt;/span&gt; &lt;span class=&quot;id identifier oa_none&quot; title=&quot;none&quot;&gt; &lt;a style=&quot;color:blue&quot; title=&quot;38925619&quot; target=&quot;_blank&quot; href=&quot;http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&amp;db=PubMed&amp;list_uids=38925619&amp;dopt=Abstract&quot;&gt; PubMed &lt;/a&gt; &lt;/span&gt; &lt;/span&gt; &lt;OnlyViewableByAuthor&gt;&lt;div class=&quot;ratings&quot;&gt; &lt;div class=&quot;journal-subject&quot;&gt;Folyóirat szakterülete: Scopus - Endocrinology&amp;nbsp;&amp;nbsp;&amp;nbsp;SJR indikátor:&amp;nbsp;Q1&lt;/div&gt; &lt;div class=&quot;journal-subject&quot;&gt;Folyóirat szakterülete: Scopus - Endocrinology, Diabetes and Metabolism&amp;nbsp;&amp;nbsp;&amp;nbsp;SJR indikátor:&amp;nbsp;Q1&lt;/div&gt; &lt;div class=&quot;journal-subject&quot;&gt;Folyóirat szakterülete: Scopus - Internal Medicine&amp;nbsp;&amp;nbsp;&amp;nbsp;SJR indikátor:&amp;nbsp;Q1&lt;/div&gt; &lt;/div&gt;&lt;/OnlyViewableByAuthor&gt; &lt;div class=&quot;publication-citation&quot; style=&quot;margin-left: 0.5cm;&quot;&gt; &lt;span title=&quot;Nyilvános idézőközlemények összesen, említések nélkül&quot; class=&quot;citingPub-count&quot;&gt;Nyilvános idéző összesen: 7&lt;/span&gt; | Független: 7 | Függő: 0 | Nem jelölt: 0 | WoS jelölt: 6 | Scopus jelölt:&amp;nbsp;4 | WoS/Scopus jelölt:&amp;nbsp;6 | DOI jelölt:&amp;nbsp;6 &lt;/div&gt;   &lt;div class=&quot;publication-citation&quot;&gt; &lt;a target=&quot;_blank&quot; href=&quot;/api/publication?cond=citations.related;eq;35077014&amp;sort=publishedYear,desc&amp;sort=title&quot;&gt; Idézett közlemények száma: 2 &lt;/a&gt; &lt;/div&gt; &lt;div class=&quot;mtid&quot;&gt;&lt;span class=&quot;long-pub-mtid&quot;&gt;Közlemény: 35077014&lt;/span&gt; | &lt;span class=&quot;status-data status-VALIDATED&quot;&gt; Egyeztetett &lt;/span&gt; Forrás Idéző | &lt;span class=&quot;type-subtype&quot;&gt;Folyóiratcikk ( Összefoglaló cikk ) &lt;/span&gt; | &lt;span class=&quot;pub-category&quot;&gt;Tudományos&lt;/span&gt; | &lt;span class=&quot;publication-sourceOfData&quot;&gt;kézi felvitel&lt;/span&gt; &lt;/div&gt; &lt;div class=&quot;lastModified&quot;&gt;Utolsó módosítás: 2025.10.07. 10:57 Gere Tamásné (SE_KK_Admin5_GT, admin) &lt;/div&gt; 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