S. Sweety, S. Panda and RR. Das (2026). Balanced electrolyte solution vs isotonic saline in the resuscitation of children with diabetic ketoacidosis: A randomized controlled trial. World journal of clinical pediatrics, 15(1), 111304. https://doi.org/10.5409/wjcp.v15.i1.111304

PubMed 41884024

[Abstract]
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.