Diabetic ketoacidosis fluid management in children: systematic review and meta-analyses

Area of Science:

• Pediatric Endocrinology
• Critical Care Medicine
• Metabolic Disorders

Background:

• Diabetic ketoacidosis (DKA) is a severe complication of type 1 diabetes mellitus in children, associated with significant morbidity and mortality.
• Optimal intravenous fluid management strategies for pediatric DKA remain a subject of clinical debate.
• Understanding the impact of fluid administration rates on DKA recovery and patient outcomes is crucial for evidence-based pediatric care.

Approach:

• A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted, searching major databases from inception to January 2022.
• Included studies focused on children under 18 years with DKA, comparing liberalized versus conservative intravenous fluid regimens.
• Data extraction and assessment were performed by two independent reviewers, focusing on key clinical outcomes.

Key Points:

• Three RCTs involving 1457 children were analyzed.
• No significant differences were observed in Glasgow Coma Scale reduction or the incidence of cerebral edema between fluid management groups.
• The conservative fluid group experienced a statistically longer time to DKA recovery (mean difference 1.42 hours).

Conclusions:

• This meta-analysis found no evidence that the rate of intravenous fluid administration impacts neurological complications or overall length of hospital stay in pediatric DKA.
• Conservative fluid management was associated with a prolonged recovery period.
• Current evidence does not support a specific fluid administration strategy over another for improving key adverse outcomes in pediatric DKA.