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Diabetic ketoacidosis fluid management in children: systematic review and meta-analyses
  1. Ali Abdalla Hamud,
  2. Khalid Mudawi,
  3. Ahmed Shamekh,
  4. Ayodeji Kadri,
  5. Colin Powell,
  6. Ibtihal Abdelgadir
  1. Paediatric Emergency Department, Sidra Medicine, Doha, Qatar
  1. Correspondence to Dr Ali Abdalla Hamud, Sidra Medicine, Doha, Qatar; alihamod5{at}


Importance Diabetic ketoacidosis (DKA) is a serious complication of type 1 diabetes mellitus, which may lead to significant morbidity and mortality.

Objectives To compare the safety and efficacy of liberalised versus conservative intravenous fluid regimens in the management of DKA in children.

Data source and study selection Databases from inception to January 2022: MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials were included. Only randomised controlled trials (RCTs) that included children aged under 18 years were assessed. Two reviewers performed data assessment and extraction.

Data extraction and synthesis Three studies out of 1536 citations were included.

Main outcomes The time to the recovery from the DKA; the frequency of paeditric intensive care unit (PICU) admissions; development of brain oedema; reduction in Glasgow Coma Scale (GCS); development of acute kidney injury and all-cause mortality.

Results We included three RCTs (n=1457). No evidence of difference was noted in the GCS reduction (risk ratio (RR)=0.77, 95% CI 0.44 to 1.36) or development of brain oedema (RR=0.50, 95% CI 0.15 to 1.68). The time to recovery from DKA was longer in the conservative group (mean difference=1.42, 95% CI 0.28 to 2.56). Time to hospital discharge, adverse or serious adverse events were comparable in the two studied groups.

Conclusion There is no evidence from this meta-analysis that rate of fluid administration has any effect on adverse neurological and other outcomes or length of hospital stay.

  • Child Health
  • Endocrinology
  • Paediatrics
  • Paediatric Emergency Medicine

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Contributors AH, ISA, KM, AK, AS, CP: study design, search and paper selection and data extraction.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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