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Initial Fluid Therapy in Pediatric Diabetic Ketoacidosis: A comparison of Hypertonic Saline Solution and Normal
1Division of Pediatric Intensive Care, Department of Pediatrics, Lady Hardinge Medical College and associated Kalawati Saran Children's Hospital, New Delhi - 110001, India.
Insights
In children with diabetic ketoacidosis (DKA), 3% saline and 0.9% saline showed similar effectiveness for initial fluid therapy. However, 3% saline may increase sodium and chloride levels without preventing cerebral edema.
Area of Science:
- Pediatric Endocrinology
- Critical Care Medicine
- Fluid and Electrolyte Balance
Background:
- Optimal fluid therapy for pediatric diabetic ketoacidosis (DKA) is debated, particularly regarding cerebral edema risk.
- Hypertonic saline solutions are used for cerebral edema treatment and volume resuscitation in pediatric shock.
Purpose of the Study:
- To compare 3% saline versus 0.9% saline for initial fluid therapy in pediatric DKA.
- To evaluate effects on vital signs, electrolytes, acid-base balance, hyperglycemia, and ketoacidosis resolution.
- To assess the incidence of cerebral edema.
Main Methods:
- Open-label prospective randomized controlled trial (RCT).
- 40 children with moderate to severe DKA were randomized.
- Initial fluid therapy administered with either 3% or 0.9% saline.
Main Results:
- No significant differences in vital parameters, hyperglycemia correction, or acidosis resolution between groups.
- 3% saline group showed higher increases in sodium and chloride levels.
- Cerebral edema incidence was similar in both groups; acidemia transiently worsened in both without clinical deterioration.
Conclusions:
- Both 0.9% and 3% saline are equally effective for initial DKA fluid therapy in children regarding hemodynamics and metabolic correction.
- 3% saline did not prevent cerebral edema and carries risks of hypernatremia, hyperchloremia, and hyperchloremic metabolic acidosis.
Introduction:
The optimal fluid therapy in children with DKA is a matter of debate, especially if we take into account its association with cerebral edema, the most important complication. Hypertonic Saline Solution is used in the treatment of cerebral edema, and also has been used for volume resuscitation in children with shock.
Aim Of Study:
To compare the effects of 3% saline and 0.9% saline solutions on changes in vital parameters, sodium and chloride levels, lactate and pH; time needed for the correction of hyperglycemia; time needed for the control of ketoacidosis and incidence of cerebral edema.
Methods:
Open-label prospective RCT in which 40 children with moderate to severe DKA were randomized to receive either 3% saline or 0.9% saline as initial fluid therapy.
Results:
There was no significant difference between the two groups in the clinical vital parameters, time for the correction of hyperglycemia and the resolution of acidosis. Patients in the 3% saline group had a higher increase in sodium and chloride from baseline compared to the 0.9% saline group. The acidemia was noted to worsen in both groups after the initiation of fluid therapy, which was not associated with clinical deterioration. The frequency of cerebral edema was similar in both groups.
Conclusions:
Both 0.9% saline and 3% saline were equally effective as initial fluid in children with DKA with respect to hemodynamic improvement, the resolution of acidosis and the correction of hyperglycemia, but the use of 3% saline solution did not preclude the development of cerebral edema and has the potential to cause hypernatremia, hyperchloremia and hyperchloremic metabolic acidosis.
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