الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are hyperglycemic emergencies that continue to account for increased burden of hospitalizations. The treatment of hyperglycemic emergencies in the pediatric population differs from that of adult populations in several important ways. One additional consideration when treating DKA and HHS in children is the potential for the development of cerebral edema. We argue that the DKA/HHS populations are unique in several ways that make the question of crystalloid fluid choice particularly relevant. Given the association between saline infusion and the development of metabolic acidosis, it would be important to know if 0.9% saline administration has the potential to worsen the already-present acidosis in DKA patients or cause or exacerbate renal injury in the DKA/HHS populations. Alternatively, a large volume administration of buffered and non-buffered crystalloid fluids that are hypotonic in comparison to 0.9% saline (ex: Ringer’s lactate or 0.45% saline) may increase the risk of cerebral edema and confusion, which may be especially relevant in pediatric populations.
To address these crystalloid fluid questions, we performed a systematic review of the literature to determine whether there are differences in clinical outcomes, biochemistries, and endocrine-specific outcomes in patients who are administered 0.9% saline as compared to other buffered and non-buffered crystalloid fluids for the treatment of hyperglycemic emergencies.
Our primary outcome was the overall mortality measured at the latest follow-up time. Secondary outcomes included mortality—as measured in-hospital, at 28 days and at 90 days—length of hospital stay, development of acute kidney injury or new requirement for renal replacement therapy, development of altered level of consciousness, time to transition to subcutaneous insulin, and time to normalization of serum bicarbonate, glucose, pH, chloride, sodium, and anion gap (arterial or venous for all serum measurements).
426 patients were included in this analysis. to determine whether there are differences in clinical outcomes, biochemistries, and endocrine-specific outcomes in patients who are administered 0.9% saline