Document Type

Article

Publication Date

10-1-2024

Comments

This article is the author's final published version in Clinical and Experimental Pediatrics, Volume 67, Issue 10, October 2024, Pages 486 - 497.

The published version is available at https://doi.org/10.3345/cep.2023.01536.

Copyright © 2024 by The Korean Pediatric Society

Abstract

Two rehydration protocols currently exist to treat diabetic ketoacidosis (DKA) in pediatric patients aged"one-bag" system and the more recent "two-bag" system. This study aimed to evaluate the safety and efficacy of the newer two-bag system versus the well-established one-bag system. The CiNAHL, Cochrane Library, Embase, PubMed, Scopus, and Web of Science databases were comprehensively searched from inception to June 2023 by 2 independent reviewers using the Preferred Reporting Items for Systematic Reviews and Meta-analysis framework. Eligible studies were those that reported participants(CRD42023427551). From the initial screening of 42 studies, 8 unique studies encompassing 583 patients met the eligibility criteria. The analysis yielded no significant intergroup differences in hypoglycemia (odds ratio, 0.61; 95% confidence interval [CI], 0.20-1.87; I2=3%) or mean glucose correction rate (mean difference [MD], 0.04 mg/ dL/hr; 95% CI, -13.10 to 13.17; I2=64%). The incidence of cerebral edema was as low (0.17%) across groups, with only one case reported in the one-bag group. Notably, the mean time to DKA resolution (MD, -3.24 h; 95% CI, -5.57 to -0.91; I2=0%) and mean response time for intravenous fluid changes (MD, -32.75 min; 95% CI, -43.21 to -22.29; I2=59%) was lower for the two-bag system. This meta- analysis presents preliminary evidence suggesting that the two-bag system may confer advantages over the one-bag system for selected patients. However, further studies with greater patient stratification based on DKA severity, fluid composition, and protocol are needed to draw definitive conclusions and elucidate the extent of these advantages.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License

Additional Files
Supplementary material 1.pdf (702 kB)
Actual search strategies
Supplementary Table 1.pdf (692 kB)
Newcastle-Ottawa Scale
Supplementary Fig. 1.pdf (701 kB)
Study selection process and PRISMA flow diagram
Supplementary Fig. 2.pdf (730 kB)

PubMed ID

38938043

Language

English

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