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Ringers lactate vs Normal saline for children with acute diarrhea and severe dehydration- a double blind randomized
Vidushi Mahajan1, Shiv Saini Sajan, Amit Sharma
1Department of Pediatrics, Government Medical College and Hospital,Chandigarh, India. vidushimahajan2003@yahoo.co.in
Insights
Ringers lactate (RL) and Normal Saline (NS) showed no significant difference in improving pH for children with severe dehydration. However, RL required less fluid and shorter hospital stays in this pediatric study.
Area of Science:
- Pediatric Emergency Medicine
- Intravenous Fluid Therapy
- Gastroenterology
Background:
- World Health Organization (WHO) guidelines recommend Ringers lactate (RL) and Normal Saline (NS) for rehydration in childhood diarrhea.
- Severe dehydration in children necessitates rapid intravenous rehydration.
Purpose of the Study:
- To compare the efficacy of RL versus NS in improving pH from baseline during rapid intravenous rehydration in children with acute diarrhea and severe dehydration.
Main Methods:
- A double-blind randomized controlled trial was conducted in pediatric emergency facilities.
- Children received either RL or NS (100 mL/kg over 3-6 hours) and were reassessed.
- Blood gas analysis was performed at baseline and after rehydration.
Main Results:
- No significant difference in pH improvement from baseline was observed between the RL and NS groups (P=0.17).
- Children receiving RL required significantly less fluid (median 310 vs 530 mL/kg, P=0.01).
- The RL group experienced a shorter median hospital stay (38 vs 51 hours, P=0.03).
Conclusions:
- Ringers lactate and Normal Saline do not differ in their ability to improve pH in pediatric patients with severe dehydration.
- RL may be associated with reduced fluid requirements and shorter hospitalizations in this population.
Objective:
WHO recommends Ringers lactate (RL) and Normal Saline (NS) for rapid intravenous rehydration in childhood diarrhea and severe dehydration. We compared these two fluids for improvement in pH over baseline during rapid intravenous rehydration in children with acute diarrhea.
Design:
Double-blind randomized controlled trial
Setting:
Pediatric emergency facilities at a tertiary-care referral hospital.
Intervention:
Children with acute diarrhea and severe dehydration received either RL (RL-group) or NS (NS-group), 100 mL/kg over three or six hours. Children were reassessed after three or six hours. Rapid rehydration was repeated if severe dehydration persisted. Blood gas was done at baseline and repeated after signs of severe dehydration disappeared.
Outcome Measures:
Primary outcome was change in pH from baseline. Secondary outcomes included changes in serum electrolytes, bicarbonate levels, and base-deficit from baseline; mortality, duration of hospital stay, and fluids requirement.
Results:
Twenty two children, 11 each were randomized to the two study groups. At primary end point (disappearance of signs of severe dehydration), the improvement in pH from baseline was not significant in RL-group [from 7.17 (0.11) to 7.28 (0.09)] as compared to NS-group [7.09 (0.11) to 7.21 (0.09)], P=0.17 (after adjusting for baseline serum Na/ Cl). Among this limited sample size, children in RL group required less fluids [median 310 vs 530 mL/kg, P=0.01] and had shorter median hospital stay [38 vs 51 hours, P=0.03].
Conclusions:
There was no difference in improvement in pH over baseline between RL and NS among children with acute diarrhea and severe dehydration.
