Author Of 1 Presentation
0.9% SALINE VERSUS PLASMA-LYTE AS INITIAL FLUID IN CHILDREN WITH DIABETIC KETOACIDOSIS- A DOUBLE BLIND RANDOMIZED CONTROLLED TRIAL
Abstract
Background
Acute kidney injury (AKI) is commonly encountered during management of Diabetic Ketoacidosis (DKA). Although adult data has shown reduced incidence of hyperchloremia and AKI with Plasma-Lyte, no study has evaluated its role in pediatric DKA.
Objectives
To compare 0.9% saline with Plasma-Lyte as initial fluid in pediatric DKA with respect to incidence of new/progressive AKI, defined as a composite outcome of creatinine (defined by KDIGO), estimated creatinine clearance (defined by p-RIFLE) and NGAL levels.
Methods
Children (>1month-12 years) with DKA, were randomized to receive either Plasma-Lyte (n= 34) or 0.9% saline (n= 32) in a double blind, parallel arm, investigator initiated, randomized controlled trial. Children with cerebral edema, chronic kidney disease or who had received pre-referral fluids and/or insulin were excluded.
Results
The incidence of new/progressive AKI was similar in both [Plasma-Lyte 3(8.8%) vs. 0.9% saline 1(3.1%);unadjusted risk ratio (95% CI)-3.0(0.29,30.44);p-0.332]. The median(IQR) time to resolution of DKA in Plasma-Lyte and 0.9% saline was 14.5(12,20) hours and 16(8,20) hours respectively. Time to resolution of AKI were similar in both [Plasma-Lyte 22.1 versus 0.9% Saline18.8 hours (adjusted HR-0.22; 95% CI: 0.02-2.30;p=0.21)]. The change in pH, chloride, bicarbonate, sodium, anion gap and effective osmolality between both groups was similar. Length of hospital stay was also similar in both [Plasma-Lyte 9(8,12) versus 0.9% Saline-10(8.25,11) days;p=0.396]
Conclusion
The incidence of new/progressive AKI and resolution of AKI were similar in 0.9% Saline and Plasma-Lyte. 0.9% Saline was non-inferior to Plasma-Lyte in time to resolution of DKA, need for RRT, mortality and lengths of PICU and hospital stay.