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Published on: August 14, 2013
5% Dextrose in Ringer's Lactate versus 5% Dextrose Normal Saline as Maintenance Intravenous Fluid Therapy in Children
Hemanth Kaviti1, Joseph John2, Krishna Mohan Gulla1
1Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), P.O. Dumduma, Bhubaneswar, 751019, Odisha, India.
Insights
This study found a statistically significant, though clinically insignificant, difference in serum chloride levels between children receiving Ringer's Lactate with 5% Dextrose (RLD5) versus 5% Dextrose Normal Saline (DNS). The incidence of acute kidney injury and hyperchloremic metabolic acidosis was low in both groups.
Area of Science:
- Pediatric critical care
- Intravenous fluid therapy
- Electrolyte balance
Background:
- Intravenous fluid selection impacts electrolyte balance in children.
- Ringer's Lactate with 5% Dextrose (RLD5) and 5% Dextrose Normal Saline (DNS) are common fluid choices.
- Understanding the differential effects on chloride levels and potential complications is crucial.
Purpose of the Study:
- To compare serum chloride levels in pediatric patients receiving RLD5 versus DNS.
- To assess the incidence of dyselectrolytemia, hyperchloremic metabolic acidosis (HCMA), acute kidney injury (AKI), and mortality in both fluid groups.
Main Methods:
- A randomized controlled trial involving 140 non-critically ill children (6 months to 14 years).
- Children received either RLD5 (intervention) or DNS (control) as maintenance intravenous fluids.
- Serum chloride, kidney function, and blood gas analysis were performed at baseline, 24 hours, and 48 hours.
Main Results:
- A statistically significant difference in mean serum chloride levels was observed at 24 hours (1.67 mEq/L, p=0.03) and 48 hours (2.78 mEq/L, p=0.01) favoring DNS.
- The incidence of AKI was low in both groups (RLD5: 1.4%-2.8%; DNS: 0%-1.4%).
- HCMA incidence was higher in the DNS group at 24 hours (14%) compared to RLD5 (2.8%), but similar at 48 hours. No mortality was reported.
Conclusions:
- While statistically significant, the observed differences in serum chloride levels between RLD5 and DNS were clinically insignificant.
- Both RLD5 and DNS demonstrated a low incidence of AKI and HCMA in this pediatric cohort.
- Further research may explore long-term outcomes and specific pediatric populations.
Objectives:
To estimate the difference in serum chloride levels between children receiving 5% Dextrose in Ringer's Lactate (RLD5) vs. 5% Dextrose Normal Saline (DNS) and to estimate the incidence of dyselectrolytemia, hyperchloremic metabolic acidosis (HCMA), acute kidney injury (AKI) and all-cause mortality in both groups.
Methods:
A randomised controlled trial was conducted in non-critically ill children aged 6 mo to 14 y, admitted between August 2021 and July 2022, requiring intravenous fluids. A sample size of 140 was estimated and randomised, with controls receiving 5% DNS and the intervention group receiving RLD5. Kidney function tests and blood gas analysis were done at admission, 24 h and 48 h after starting the maintenance IV fluid, and outcomes were analysed at 24 h and 48 h. Data was collected using a pre-designed data collection form that included demographic and clinical profile details, and outcomes were analysed using SPSS Version 20 software.
Results:
Seventy-one children per group were enrolled. The mean chloride difference between the two groups at 24 and 48 h were 1.67 (p-value 0.03) and 2.78 (p-value 0.01), respectively. The incidence of AKI at 24 h and 48 h was 1.4% and 2.8% in the RLD5 group and 0% and 1.4% in the DNS group, respectively. At 24 h and 48 h, 2.8% and 2.8% of children had HCMA in the RLD5 group, and 14% and 4.2% had HCMA in the DNS group, respectively. There was no mortality in either group.
Conclusions:
Though clinically insignificant, there was a statistically significant difference in the serum chloride levels between the groups.
