Types of fluid therapy for pediatric patients with diabetic ketoacidosis: a systematic review
Authors' conclusion
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.
Study context
- Population
- Pediatric patients with diabetic ketoacidosis (DKA); articles published since 2004
- Comparison
- Balanced fluids vs normal saline (NS); 0.45% saline vs NS; rapid vs slow rehydration
Pooled result
As reported in the abstract
- Weak evidence suggests balanced solutions may be superior to NS in some areas, such as shorter time to DKA resolution
- No significant differences between some balanced solutions and NS for most outcomes (acute kidney injury, hospital stay, mortality)
- No significant differences in neurological complications or speed of DKA resolution with 0.45% saline vs NS; NS associated with more frequent electrolyte disturbances, such as hyperchloremic metabolic acidosis
- No strong evidence that rapid-rate rehydration increases major complications, although it is linked to more hyperchloremic metabolic acidosis
Original publication
Types of fluid therapy for pediatric patients with diabetic ketoacidosis: a systematic review. Diabetes Res Clin Pract. Published 9 October 2025. doi:10.
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