Types of fluid therapy for pediatric patients with diabetic ketoacidosis: a systematic review

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice Pub Date : 2025-10-09 DOI:10.1016/j.diabres.2025.112926

Patricia Campos Magallón, Ingrid Royo Sesma, Julio Alberto Vázquez Gómez, María Ruiz Del Campo, Mª Yolanda Ruiz Del Prado

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Abstract

There is ongoing debate regarding the optimal fluid therapy for treating diabetic ketoacidosis (DKA) in pediatric patients. This paper reviews the evidence comparing balanced fluids with normal saline (NS), examines the best fluid tonicity and the effects of rapid versus slow rehydration rates for the treatment of DKA, based on articles published since 2004.

Weak evidence suggests that balanced solutions (Ringer’s, Hartmann’s) may be superior to NS in some areas, such as shorter time to DKA resolution. However, no significant differences were found between some balanced solutions and NS regarding most outcomes (acute kidney injury, hospital stay, or mortality).

There are no significant differences in neurological complications or the speed of DKA resolution when comparing 0.45% saline to NS, although NS is associated with more frequent electrolyte disturbances, such as hyperchloremic metabolic acidosis.

There is no strong evidence that rapid-rate rehydration DKA resolution or increases major complications, although it is linked to more hyperchloremic metabolic acidosis.

Current evidence suggests that balanced solutions and 0.45% saline are not inferior to NS in pediatric DKA, but evidence is insufficient to recommend them over NS. There is no evidence that rapid-rate rehydration increases major complications. More studies are needed to provide further evidence.

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小儿糖尿病酮症酸中毒的液体治疗类型：系统综述

关于治疗小儿糖尿病酮症酸中毒（DKA）的最佳液体疗法一直存在争议。本文根据2004年以来发表的文章，综述了平衡液体与生理盐水（NS）比较的证据，探讨了最佳的液体补剂以及快速和缓慢补液率对治疗DKA的影响。微弱的证据表明，平衡溶液（Ringer 's, Hartmann 's）可能在某些方面优于NS，例如更短的时间到DKA分辨率。然而，在大多数结果（急性肾损伤、住院时间或死亡率）方面，一些平衡解决方案与NS之间没有发现显著差异。虽然NS与高氯血症代谢性酸中毒等更频繁的电解质紊乱相关，但0.45%生理盐水与NS相比，在神经系统并发症或DKA解决速度方面没有显著差异。没有强有力的证据表明快速补液能解决DKA或增加主要并发症，尽管它与更多的高氯血症代谢性酸中毒有关。目前的证据表明，在小儿DKA中，平衡溶液和0.45%生理盐水并不逊于NS，但证据不足以推荐它们优于NS。没有证据表明快速补液会增加主要并发症。需要更多的研究来提供进一步的证据。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Diabetes research and clinical practice 医学-内分泌学与代谢

CiteScore

10.30

自引率

3.90%

发文量

862

审稿时长

32 days

期刊介绍： Diabetes Research and Clinical Practice is an international journal for health-care providers and clinically oriented researchers that publishes high-quality original research articles and expert reviews in diabetes and related areas. The role of the journal is to provide a venue for dissemination of knowledge and discussion of topics related to diabetes clinical research and patient care. Topics of focus include translational science, genetics, immunology, nutrition, psychosocial research, epidemiology, prevention, socio-economic research, complications, new treatments, technologies and therapy.