Effectiveness of various balanced electrolyte solutions in the resuscitation of patients with diabetic ketoacidosis: A pairwise meta-analysis and network meta-analysis

Lote, VB; Sharma, VS; Vyas, G; Shenoy, AK

doi:10.1016/j.diabres.2026.113645

Type 1 diabetes

Effectiveness of various balanced electrolyte solutions in the resuscitation of patients with diabetic ketoacidosis: A pairwise meta-analysis and network meta-analysis

Diabetes Res Clin PractPublished 7 Nov 2026pairwise meta-analysis and network meta-analysis

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Authors' conclusion

Thus, compared to NS, BES improved PBL and PCL, with faster time to DKA resolution and shorter LHS, but did not consistently improve adverse clinical outcomes. Comparison among BESs is indirect and hypothesis-generating; thus, direct head-to-head trials using patient-related outcomes are required in future trials.

Study context

Population: Patients with diabetic ketoacidosis (DKA) resuscitated with balanced electrolyte solutions (BES) or normal saline (NS)meta-analysis of BES vs NS (studies) 18 · network meta-analysis of various BES (studies) 16

Comparison: BES compared with normal saline; network meta-analysis of various BES
Outcome: Time to DKA resolution

Pooled result

As reported in the abstract

Each group vs NSMD, h (95 % CI)P value

BES

−4.41(−7.00 to −1.82)

Sterofundinnetwork meta-analysis

−4.30(−6.14 to −2.46)

P < 0.0001

RLnetwork meta-analysis

−2.60(−4.13 to −1.07)

P = 0.0009

Further pooled results

Outcome	← Lower vs NS ←→ Higher vs NS →	MD (days) (95 % CI)	P value
Length of hospital stay (LHS)BESvs NS	−1.5−1−0.500.5	−0.43 (−0.72 to −0.14)
Length of hospital stay (LHS)Sterofundinvs NSNetwork meta-analysis	−1.5−1−0.500.5	−0.67 (−1.15 to −0.19)	P = 0.0066
	−1.5−1−0.500.5Difference, days (linear scale)

Outcome	← Lower vs NS ←→ Higher vs NS →	MD (mmol/L) (95 % CI)	P value
Postresuscitation bicarbonate levels (PBL)BESvs NSSignificant heterogeneity	−10−505	1.20 (0.48,1.92)
Postresuscitation bicarbonate levels (PBL)PLvs NSNetwork meta-analysis · significant heterogeneity	−10−505	2.16 (1.12,3.20)	P < 0.0001
Postresuscitation bicarbonate levels (PBL)RLvs NSNetwork meta-analysis · significant heterogeneity	−10−505	1.24 (0.75,1.73)	P < 0.0001
Postresuscitation chloride levels (PCL)BESvs NSSignificant heterogeneity	−10−505	−3.31 (−5.32 to −1.29)
Postresuscitation chloride levels (PCL)RLvs NSNetwork meta-analysis · significant heterogeneity	−10−505	−6.22 (−6.69 to −5.76)	P < 0.0001
Postresuscitation chloride levels (PCL)Sterofundinvs NSNetwork meta-analysis · significant heterogeneity	−10−505	−3.60 (−5.10 to −2.10)	P < 0.0001
Postresuscitation chloride levels (PCL)PLvs NSNetwork meta-analysis · significant heterogeneity	−10−505	−3.16 (−4.58 to −1.73)	P < 0.0001
	−10−505Difference, mmol/L (linear scale)

Safety

Outcome	← Lower odds with RL ←→ Higher odds with RL →	OR (95 % CI)
HyperkalemiaRLvs NS	0.050.21520	4.06 (1.17,14.15)
Acute kidney injuryRLvs NS	0.050.21520	2.26 (1.00,5.08)
	0.050.21520Odds ratio (log scale)

Original publication

Effectiveness of various balanced electrolyte solutions in the resuscitation of patients with diabetic ketoacidosis: A pairwise meta-analysis and network meta-analysis. Diabetes Res Clin Pract. Published 7 November 2026. doi:10.1016/j.diabres.2026.113645

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