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Fluid Resuscitation in Hyperglycemic Crises: A Systematic Review of the Two-Bag Method Versus Standard Therapy in the Emergency Department


Authors : Bledar Hysenbelli; Elona Xhardo; Aderisa Xhetani; Dorina Ylli

Volume/Issue : Volume 11 - 2026, Issue 7 - July

Google Scholar : https://tinyurl.com/mwht83n8

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DOI : https://doi.org/10.38124/ijisrt/26jul575

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Abstract : Background: Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) represent life-threatening hyperglycemic emergencies requiring aggressive fluid resuscitation as a cornerstone of management. Traditional one-bag fluid protocols, which combine dextrose and electrolytes in a single intravenous bag, have been the standard approach in emergency departments for decades. However, the two-bag method employing separate bags for isotonic crystalloid and dextrosecontaining fluids ,has emerged as an alternative strategy offering potential advantages in metabolic recovery and safety outcomes.  Objectives: This review synthesizes current evidence comparing the two-bag method with standard one-bag protocols in the emergency department management of hyperglycemic crises, evaluating efficacy, safety, and clinical outcomes across adult and pediatric populations.  Clinical Significance: The adoption of two-bag fluid administration protocols represents a meaningful advancement in emergency department management of hyperglycemic crises. By enabling independent adjustment of dextrose and electrolyte administration rates without requiring bag changes, this method reduces resource utilization, minimizes iatrogenic complications, and accelerates metabolic recovery.  Conclusions and Future Directions: While accumulating evidence supports two-bag methodology, further research is needed to define optimal protocols across diverse patient populations, clarify electrolyte replacement strategies, and establish consensus guidelines for implementation.

Keywords : Diabetic Ketoacidosis, Fluid Resuscitation, Emergency Department Management.

References :

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Background: Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) represent life-threatening hyperglycemic emergencies requiring aggressive fluid resuscitation as a cornerstone of management. Traditional one-bag fluid protocols, which combine dextrose and electrolytes in a single intravenous bag, have been the standard approach in emergency departments for decades. However, the two-bag method employing separate bags for isotonic crystalloid and dextrosecontaining fluids ,has emerged as an alternative strategy offering potential advantages in metabolic recovery and safety outcomes.  Objectives: This review synthesizes current evidence comparing the two-bag method with standard one-bag protocols in the emergency department management of hyperglycemic crises, evaluating efficacy, safety, and clinical outcomes across adult and pediatric populations.  Clinical Significance: The adoption of two-bag fluid administration protocols represents a meaningful advancement in emergency department management of hyperglycemic crises. By enabling independent adjustment of dextrose and electrolyte administration rates without requiring bag changes, this method reduces resource utilization, minimizes iatrogenic complications, and accelerates metabolic recovery.  Conclusions and Future Directions: While accumulating evidence supports two-bag methodology, further research is needed to define optimal protocols across diverse patient populations, clarify electrolyte replacement strategies, and establish consensus guidelines for implementation.

Keywords : Diabetic Ketoacidosis, Fluid Resuscitation, Emergency Department Management.

Paper Submission Last Date
31 - July - 2026

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