Albumin-Crystalloid Synergy for Fluid-Restricted Case of Diabetic Ketoacidosis: A Volume-Sparing Strategy in a Critically Ill Patient

Abstract

ABSTRACT

Aggressive fluid resuscitation remains a cornerstone in the management of diabetic ketoacidosis (DKA) besides insulin therapy and electrolyte correction. However, patients with fluid-sensitive comorbidities like heart failure and chronic kidney disease, where the boundary between benefit and harm is dangerously thin, may find this approach hazardous. We present a critically ill 62-year-old man with poorly controlled type 2 diabetes mellitus, heart failure with reduced ejection fraction (HFrEF), and stage V chronic kidney disease (CKD) who developed DKA with urosepsis. Given his fluid restriction, conventional therapy risked catastrophic fluid overload. A volume-sparing approach was employed, combining 5% human albumin, followed by a carefully titrated balanced crystalloid. This strategy achieved rapid metabolic correction without precipitating pulmonary or cardiac decompensation. This case presents a volume-sparing strategy: the synergistic administration of albumin and crystalloids. This tailored approach offers a safe, effective, and physiologically sound alternative to conventional high-volume protocols, addressing a critical therapeutic gap in fluid-restricted DKA patients.