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DIABETIC KETOACIDOSIS FLUID MANAGEMENT IN CHILDREN: SYSTEMATIC REVIEW AND META-ANALYSES
- Ali Hamud (Qatar)
Abstract
Background and Aims
Diabetic Ketoacidosis (DKA) is a serious complication of type 1 Diabetes Mellitus (DM), which may lead to significant morbidity and mortality.
The aim is to compare the safety and efficacy of liberalised versus conservative intravenous fluid (IV fluid) regimens in the management of DKA in children.
Methods
Databases from inception to January 2022: MEDLINE, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials (CENTRAL) were included. Only randomised controlled trials that included children aged under 18 years were assessed. Two reviewers performed data assessment and extraction.
Three studies out of 1536 citations were included in this review.
Results
The outcomes are the time to the recovery from the DKA; the frequency of PICU admissions; development of brain oedema; reduction in (Glasgow Coma Scale) GCS; development of acute kidney injury; and all-cause mortality.
We included 3 RCTs (n=768). No evidence of differences were noted in the episodes of GCS reduction (RR= 0.6, 95% CI 0.32 to 1.44), development of brain oedema (RR= 0.66, 95% CI 0.11 to 3.94), or the duration to the recovery (MD= 2.17. 95% CI -1.84 to 6.19, I2 = 99%). Time to hospital discharge, adverse or serious adverse events were comparable in the two studied groups.
Conclusions
There is low to very low certainty of evidence that the rate of IV fluid administration in DKA has no effects on the development of brain oedema or injury, duration of hospital stay or the risk of adverse or serious adverse events.