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5% Dextrose in Ringer’s Lactate versus 5% Dextrose Normal Saline as Maintenance Intravenous Fluid Therapy in Children — A Randomised Controlled Trial

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Indian Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Objectives

To estimate the difference in serum chloride levels between children receiving 5% Dextrose in Ringer’s Lactate (RLD5) vs. 5% Dextrose Normal Saline (DNS) and to estimate the incidence of dyselectrolytemia, hyperchloremic metabolic acidosis (HCMA), acute kidney injury (AKI) and all-cause mortality in both groups.

Methods

A randomised controlled trial was conducted in non-critically ill children aged 6 mo to 14 y, admitted between August 2021 and July 2022, requiring intravenous fluids. A sample size of 140 was estimated and randomised, with controls receiving 5% DNS and the intervention group receiving RLD5. Kidney function tests and blood gas analysis were done at admission, 24 h and 48 h after starting the maintenance IV fluid, and outcomes were analysed at 24 h and 48 h. Data was collected using a pre-designed data collection form that included demographic and clinical profile details, and outcomes were analysed using SPSS Version 20 software.

Results

Seventy-one children per group were enrolled. The mean chloride difference between the two groups at 24 and 48 h were 1.67 (p-value 0.03) and 2.78 (p-value 0.01), respectively. The incidence of AKI at 24 h and 48 h was 1.4% and 2.8% in the RLD5 group and 0% and 1.4% in the DNS group, respectively. At 24 h and 48 h, 2.8% and 2.8% of children had HCMA in the RLD5 group, and 14% and 4.2% had HCMA in the DNS group, respectively. There was no mortality in either group.

Conclusions

Though clinically insignificant, there was a statistically significant difference in the serum chloride levels between the groups.

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Acknowledgements

The authors acknowledge Dr. Aravinda C, for helping with the statistical analysis.

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Authors and Affiliations

  1. Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), P.O. Dumduma, Bhubaneswar, 751019, Odisha, India

    Hemanth Kaviti, Joseph John & Krishna Mohan Gulla

  2. Department of Biochemistry, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India

    Suchanda Sahu

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  1. Hemanth Kaviti
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  2. Joseph John
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  3. Krishna Mohan Gulla
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  4. Suchanda Sahu
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Contributions

HK participated in the conceptualization of the study, collected data, carried out the statistical analyses, and drafted the initial manuscript; JJ and KMG conceptualized and designed the study, supervised data collection and critically reviewed and revised the manuscript; SS participated in the conceptualization of the study, ensured lab standards and tests and critically reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work. JJ will act as guarantor for this manuscript.

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Correspondence to Joseph John.

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Kaviti, H., John, J., Gulla, K.M. et al. 5% Dextrose in Ringer’s Lactate versus 5% Dextrose Normal Saline as Maintenance Intravenous Fluid Therapy in Children — A Randomised Controlled Trial. Indian J Pediatr (2024). https://doi.org/10.1007/s12098-024-05077-2

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