5% Dextrose in Ringer’s Lactate versus 5% Dextrose Normal Saline as maintenance intravenous fluid therapy in Children - A Randomised Controlled Trial

Abstract

Abstract Rationale: Our study compares the effects of 5% Dextrose in Ringer’s Lactate versus 5% Dextrose Normal Saline as maintenance fluid therapy to nullify iatrogenic hyperchloremia, hyperchloremic metabolic acidosis (HCMA) caused by NS. Objectives To estimate the difference in serum chloride levels between the children receiving 5% Dextrose in Ringer’s Lactate versus 5% Dextrose Normal Saline and to estimate the incidence of dyselectrolytemia, HCMA, acute kidney injury and all-cause mortality in both groups. Methods A randomised controlled trial was conducted on children aged 6 months to 14 years admitted to AIIMS, Bhubaneswar, between August 2021 and July 2022, with controls receiving 5% Dextrose Normal Saline and the Intervention group receiving 5% Dextrose in Ringer’s Lactate. Results: A total of 142 children (71 in each group) were enrolled. The mean chloride difference between the two groups at 24 hours and 48 hours was 1.67 (p-value − 0.03) and 2.78 (p-value – 0.01), respectively. At 24h, 1.4% of children had AKI in the RLD5 group, and no one had AKI in the DNS group. At 48h, 2.8% in the RLD5 group and 1.4% in the DNS group had AKI. At 24h, 2.8% of children had HCMA in the RLD5 group, and 14% of children had HCMA in the DNS group (p-value − 0.02). At 48h, 2.8% of children had HCMA in the RLD5 group, and 4.2% had HCMA in the DNS group. There was no mortality in either group. Conclusion Though clinically insignificant, there was a statistically significant difference in the serum chloride levels between the groups. Ethical approval and CTRI Registration: IEC/AIIMS BBSR/PG Thesis/2020-21/97 dated December 21, 2020; Clinical Trial Registry India (CTRI) (www.ctri.nic.in) vide registration number CTRI/2021/08/035924 dated 25/08/2021.