5% Dextrose in Ringer’s Lactate Or 5% Dextrose Normal Saline: What should you choose for Maintenance Intravenous Fluid Therapy in Children?

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

The study performed Kidney function tests and blood gas analysis at admission, 24 h and 48 h after starting the maintenance IV fluid, and analyzed outcomes at 24 h and 48 hours. It observed-

• The mean chloride difference between the two groups at 24 and 48 h was 1.67 and 2.78, respectively. 
• The incidence of AKI at 24 h and 48 h was 1.4% and 2.8%, respectively, in the RLD5 group 
• The incidence of AKI at 24 h and 48 h was 0% and 1.4%, respectively, in the DNS group. 
• At 24 h and 48 h, 2.8% and 2.8% of children had HCMA in the RLD5 group,
•  At 24 h and 48 h, 14% and 4.2% of children had HCMA in the DNS group.
• No mortality in either group.

Although clinically insignificant, the study shows significant differences in the serum chloride levels between the groups. These results warrant consideration when selecting intravenous fluid therapy for pediatric patients, emphasizing the need for further research to elucidate optimal fluid choices for this population.

Kaviti H, John J, Gulla KM. 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