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💧 DKA resuscitation: Normal Saline vs Ringer’s Lactate, does it really matter?
For decades, 0.9% NaCl has been the default fluid in diabetic ketoacidosis.
But… is it still the best choice?
🧪 New randomized ICU data (2025-2026)
👉 88 patients with severe DKA
👉 Ringer’s Lactate (RL) vs Normal Saline (NS)
👉 Same insulin protocol
📊 Primary outcome: DKA resolution at 48h
➡️ No difference
• RL: 56.5%
• NS: 50%
(p = 0.66)
⚖️ So… clinically equivalent? Not exactly.
The physiology tells a different story 👇
🧠 What RL does better
Compared to NS:
✔️ Higher bicarbonate early
✔️ Better potassium levels
✔️ Lower chloride at 48h
➡️ Translation:
• Less hyperchloremic metabolic acidosis
• Lower risk of hypokalemia
• More physiologic acid-base recovery
⚠️ What NS still does
❗ Same DKA resolution speed
❗ Same ICU stay
❗ Same mortality
➡️ So endpoints look “equal”…
…but physiology is not.
🚨 Why this matters in real ICU practice
Hyperchloremia is not benign:
• Worsens metabolic acidosis
• Increases respiratory workload
• Promotes renal vasoconstriction
• Delays recovery
And hypokalemia?
• Arrhythmias
• Insulin resistance
• Delayed metabolic correction
🧬 Clinical interpretation
This is not about:
❌ “Which fluid resolves DKA faster?”
This is about:
➡️ Which fluid creates a better internal environment for recovery
🔥 Take-home message
👉 NS is acceptable
👉 RL is physiologically smarter
➡️ Especially in:
• Severe acidosis
• High chloride states
• Patients at risk of hypokalemia
📚 Trifi A. et al. (2025)
Medicina Intensiva
doi.org/10.1016/j.medi…

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Eish unfortunately, I do need to be out on weekends spending money
Mamello🧚🏽♀️@MelloFelicia1
Normalize bed rotting on the weekends and enjoying the peace of your home. You don’t have to go out and spend money every single weekend.
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But when Nonku wore one to a high tea, they were all upset
Unknown@_is_kunta
Nothing beats a ROBERTO CAVALLI Dress
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Jamie so he can perform gang gang after the ceremony
Idris Elbow 💪🏾@YallLuvCris
You’ve just gotten married. And there’s enough money leftover in the budget to have one of these four sing at your reception. Who’s singing at your reception?
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It really was irking me so bad
𝐕𝐈@6uhle
istg if I hear “big mommy” one more time from these silly twins
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Lmfaoooo she killed me
KM.@khanyamkuhlu_
Mam’Winnie was an iconic for this line “ I am grateful to no one, it was my right to be at home “
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After a month of trauma for my family….im finally back at home.
A very deep thank you to my somdala @thandiswamazwai for looking after me for the past month. For coming to the hospital EVERYDAY because I didn’t like the hospital food 🥹for being there every morning to make sure I take my protein shake and forcing me. For sneaking into my ward just to bring me comfort things and bringing me my own linen. For taking me from the hospital and allowing me to stay with her as she nursed me back to health with her beautiful partner….who went beyond the call of duty. Thank you to my sister in law for all the fights about me having to gain weight. (I was so skinny guys) Thank you again sis Thandiswa For checking in on me every morning and making sure I get out of bed and joined you to watch trash tv. I even watched uthando nesthembu 😂for our film club watching old movies we used to watch with mama. Pretty Woman, Oliver Twist, My Girl…. For feeding me everyday wit your groceries 😅 Thank you for waking up all the nights I was having nightmares to come run my back. Thank you for reminding me that mama didn’t leave me alone, she left me with you.
My Mamkhulu who came to babysit me for a weekend. 🥹🥹🥹
My mama Angola who loves me fiercely and was there every step. ❤️
My baby sister @nomisupasta who found me half alive end of March and rushed me to the hospital without flinching or shedding a tear when she saw her big sister hanging onto life on a thin string. I had a combination of Malaria and pneumonia, so I can just imagine what I looked like. As well as jaundice. I wouldn’t have lived if Nomi hadn’t heeded my call on the Sunday I called and said, ‘Nomsa, ndiyaphela mntanasekhaya.’ And she came rushing over. Thank you to the uber driver who didn’t make her pay to come to me and go to the hospital.
Thank you to my huge enormous family who ALL came to the hospital. They were literally fighting for slots 🥹🥹🥹
Thank you for all the messages across the country. My cousins 🥹My aunts and my uncles for their love.
My parents for paying bills they never saw coming yikes 😅🥹🥰
Thank you to my childhood friends Boni and Tshols for the visits and the pyjama party, and filling me with energy. It is our friends who make us laugh. Thank you for all the giggles.
Thank you for my other friends who sent me food and helped me get back into life.
Thank you to all the doctors at Milpark and Charlotte Maxeke for using their their talents to heal me. But to be honest , thank you more to Charlotte Maxeke. Guys our public health care system DOES work. And it’s fine. Ignore the elitism.
Mostly thank you to my creator for helping me fight and pull thru and giving me another chance at life.
I hope I haven’t forgotten anyone.
This season of illness showed me all my blessings.
Ndiyabulela 🙏🏿
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Prophet Uebert Angel
Nithya Shri@Nithya_Shrii
Your first day in heaven who you going to look for?
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