Fluid choice in pediatric diabetic ketoacidosis: a Systematic Review and Meta-Analysis.
Amanda A Rabelo, Júlia F C E Oliveira, Luís F Oliveira et al.
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In 30 seconds
This systematic review and meta-analysis compared balanced electrolyte solutions (BES) with 0.9% saline for fluid resuscitation in children with diabetic ketoacidosis (DKA), including randomized trials and observational studies. Across eight studies comprising 47,840 participants, randomized-trial analyses found no significant difference in time to DKA resolution (n = 292; MD 2.27 h; 95% CI - 0.58 to 5.11) or hospital length of stay (n = 225; MD 0.11 days; 95% CI - 0.75 to 0.97). The authors concluded that evidence is insufficient to establish superiority, inferiority, or comparative safety of either fluid strategy.
Key findings
- In randomized trials, time to DKA resolution did not differ significantly: MD 2.27 h; 95% CI - 0.58 to 5.11.
- Hospital length of stay did not differ significantly: MD 0.11 days; 95% CI - 0.75 to 0.97.
- Risks of cerebral edema and acute kidney injury did not differ significantly between groups; estimates were imprecise.
Why it matters
Fluid selection in pediatric DKA is clinically important, and BES have been proposed as an alternative because saline’s chloride content may contribute to hyperchloremic acidosis. This analysis found no demonstrated advantage in clinical outcomes with BES, but the available evidence also does not establish that the strategies are equivalent or comparably safe. The findings highlight uncertainty rather than a basis for changing fluid protocols.
What to keep in mind
The authors state that additional high-quality studies are needed. The randomized-trial analyses included relatively small numbers for several outcomes, and confidence intervals for complications were wide.