pem pearl: ivf in dka
A true double-blind RCT in pediatrics? They do exist!
Here is a study out of India comparing Lactated Ringers vs 0.9%Normal Saline as the INITIAL fluid used to resuscitate/rehydrate patients presenting in DKA. (Emphasis on initial as after the blood sugar dropped below 250, D5NS was the maintenance fluid utilized)
Background: NS has been associated with hyperchloremia which can worsen acidosis and potentially prolong time to resolution of DKA (chloride content of NS 154 mEq/L compared to 110mEq/L in LR)
The Study: they enrolled 67 patients aged 3-9 years over a 1 year trial; 33 in the LR group and 34 in the NS group. Mostly new-onset diabetics. Groups were generally well randomized though notably the LR group had more patients in severe DKA.
Results: DKA resolution was about 4 hours faster (12.9 vs 16.8 hours) in the LR vs the NS group. Secondary outcomes showed a higher rise in chloride in the NS group (+8.7 vs 3.9 at 4 hours, +10.8 vs 4.4 at 8 hours). There was also a statistically higher rise in Bicarb in the LR group at 12 hours.
Bottom Line: In this smaller study out of India (generalizability?), pediatric patients presenting in DKA had faster resolution of DKA when Lactated Ringers was used as the initial fluid for resuscitation/rehydration compared to 0.9% NS.
Here is a study out of India comparing Lactated Ringers vs 0.9%Normal Saline as the INITIAL fluid used to resuscitate/rehydrate patients presenting in DKA. (Emphasis on initial as after the blood sugar dropped below 250, D5NS was the maintenance fluid utilized)
Background: NS has been associated with hyperchloremia which can worsen acidosis and potentially prolong time to resolution of DKA (chloride content of NS 154 mEq/L compared to 110mEq/L in LR)
The Study: they enrolled 67 patients aged 3-9 years over a 1 year trial; 33 in the LR group and 34 in the NS group. Mostly new-onset diabetics. Groups were generally well randomized though notably the LR group had more patients in severe DKA.
Results: DKA resolution was about 4 hours faster (12.9 vs 16.8 hours) in the LR vs the NS group. Secondary outcomes showed a higher rise in chloride in the NS group (+8.7 vs 3.9 at 4 hours, +10.8 vs 4.4 at 8 hours). There was also a statistically higher rise in Bicarb in the LR group at 12 hours.
Bottom Line: In this smaller study out of India (generalizability?), pediatric patients presenting in DKA had faster resolution of DKA when Lactated Ringers was used as the initial fluid for resuscitation/rehydration compared to 0.9% NS.
