Balanced electrolyte solution vs isotonic saline in the resuscitation of children with diabetic ketoacidosis: A randomized controlled trial.

BACKGROUND

Fluid therapy is a cornerstone in the management of diabetic ketoacidosis (DKA). Normal saline (NS, 0.9%) has traditionally been the fluid of choice; however, concerns about its association with hyperchloremic metabolic acidosis and possible development of acute kidney injury (AKI) have led to an increased interest in balanced electrolyte solutions (BES) as a potentially safer alternative.

AIM: To compare BES with NS in the initial resuscitation of children with DKA.

METHODS

This double-blind, parallel, randomized controlled trial (RCT) was conducted in the Pediatrics department of a tertiary care teaching hospital over two-year period. Children aged 5 to 14 years with DKA as defined by the "International Society for Pediatric and Adolescent Diabetes" were included. The primary objective was-the time taken to resolution of acidosis. Secondary objectives were-effect on electrolyte imbalances, development of cerebral edema or AKI, and other clinical outcomes.

RESULTS

Sixty patients were enrolled. The mean (SD) age of the patients was 10.7 (1.42) years, and majority were female (73.3%). The time (hour) taken for resolution of acidosis was not significantly different (P = 0.16). The NS group had a higher incidence of hyperchloremia (P = 0.09), AKI (P = 0.07), and prolonged hospitalization (P = 0.23), but all these were not statistically significant. Other outcomes were comparable in both the groups.

CONCLUSION

This trial did not find any significant difference between BES and NS (0.9%) in the initial resuscitation of children with DKA.