The use of balanced solution appears to be of slight benefit in children with severe dehydration following acute diarrhea
The use of balanced solution appears to be of slight benefit in children with severe dehydration following acute diarrhea
SOURCE
Florez ID, Sierra J, Pérez-Gaxiola G.
Balanced crystalloid solutions versus 0.9% saline for treating acute diarrhea and severe dehydration in children.
Cochrane Database of Systematic Reviews 2023, Issue 5. Art. No.: CD013640. DOI:10.1002/14651858.CD013640.pub2
CONTEXT
In the event of acute diarrhea and severe dehydration in children, management may require the administration of intravenous fluids. The most commonly used solution is 0.9% isotonic saline solution (ISS). Balanced solutions, recommended in the management of sepsis, have a composition closer to human plasma and limit the risk of hyperchloremic acidosis.
CLINICAL QUESTIONS
What are the advantages and disadvantages of administering balanced solutions to children requiring rehydration for severe dehydration (as defined by the WHO) due to acute diarrhea?
BOTTOM LINE
Compared with ISS, balanced solutions (lactated Ringer's evaluated in 4 studies and Plasma-Lyte in 1 study) are associated with a modest reduction in hospital length of stay (moderate level of evidence). The effect of balanced solutions on in-hospital mortality is uncertain (very low level of evidence). The use of balanced solutions seems to be associated with a higher pH and a lower risk of hypokalemia (low level of evidence). The use of balanced solutions does not appear to be associated with a different volume of rehydration (low level of evidence). No notable disadvantages were observed in the studies analyzed.
CAVEATS
The use of balanced solutions compared to ISS in children with severe dehydration following acute diarrhea appears to provide a slight clinical benefit, but with a low level of evidence. Further, larger, blinded studies would provide a better answer to this question.
AUTHORS
Mathieu Oberlin
mathieu.oberlin@outlook.fr
Centre hospitalier de Selestat, F-67600 Sélestat, France
Peter Jones
peter.jones@aphp.fr
SAMU de Paris, 75015 Paris, France
