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World J Diabetes. Aug 15, 2026; 17(8): 121563
Published online Aug 15, 2026. doi: 10.4239/wjd.121563
Published online Aug 15, 2026. doi: 10.4239/wjd.121563
Non-invasive haemodynamic monitoring to individualise fluid resuscitation in adult diabetic ketoacidosis: A randomized controlled pilot trial
Yan Bo, Department of Medicine, Northwest Minzu University, Lanzhou 730030, Gansu Province, China
Hao-Jie Li, Zhuan-Zhuan Han, Yi-Fei Chen, Department of Emergency Medicine, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou 225012, Jiangsu Province, China
Hao-Jie Li, Department of Emergency Medicine, Taizhou Central Hospital, Taizhou University Hospital, Taizhou 318000, Zhejiang Province, China
Li-Jun Tian, Department of Critical Care Medicine, Nantong Third People’s Hospital, Affiliated Nantong Hospital 3 of Nantong University, Nantong 226001, Jiangsu Province, China
Co-first authors: Yan Bo and Hao-Jie Li.
Co-corresponding authors: Li-Jun Tian and Yi-Fei Chen.
Author contributions: Bo Y and Li HJ contributed equally to this article, they are the co-first authors of this manuscript; Bo Y, Li HJ, Han ZZ, and Tian LJ researched data and reviewed and edited the manuscript; Bo Y and Chen YF researched data, contributed to discussion, and wrote the first draft of the manuscript; Bo Y reviewed and edited the manuscript; Chen YF is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis; Tian LJ and Chen YF contributed equally to this article, they are the co-corresponding authors of this manuscript; and all authors approved the final version of the manuscript.
AI contribution statement: The authors in the current manuscript have not used any AI tools for any purpose.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Yangzhou University Affiliated Hospital, approval No. 2022-YKL3-06-004.
Clinical trial registration statement: The protocol was registered with the Chinese Clinical Trial Registry, No. ChiCTR2500103388 and conducted in accordance with CONSORT guidelines.
Informed consent statement: All participants provided written informed consent prior to enrolment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: The de-identified data supporting this study are available from Yifei Chen upon reasonable request, subject to institutional ethics approval.
Corresponding author: Yi-Fei Chen, MD, Department of Emergency Medicine, The Affiliated Hospital of Yangzhou University, Yangzhou University, No. 368 Hanjiang Middle Road, Yangzhou 225012, Jiangsu Province, China. 090484@yzu.edu.cn
Received: March 27, 2026
Revised: June 9, 2026
Accepted: July 2, 2026
Published online: August 15, 2026
Processing time: 131 Days and 15.7 Hours
Revised: June 9, 2026
Accepted: July 2, 2026
Published online: August 15, 2026
Processing time: 131 Days and 15.7 Hours
Core Tip
Core Tip: Diabetic ketoacidosis requires urgent fluid resuscitation, yet standard protocols only adopt static volume assessment. This Chinese emergency department mixed-methods study develops a non-invasive doppler strategy combining ultrasonic cardiac output monitoring and passive leg raising for personalised adult diabetic ketoacidosis rehydration. Compared with guideline routine care, it safely lowers 72-hour net fluid balance and hospital stays without harming metabolic or renal recovery. Feasible at bedside, it reduces iatrogenic fluid overload and lessens resource pressure in under-resourced emergency settings without invasive monitors.