Skip to main content Accessibility help
×
Home

Does the addition of dextrose to IV crystalloid therapy provide clinical benefit in acute dehydration? A systematic review and meta-analysis

  • Ashley Grigsby (a1) (a2), Jennifer Herron (a3) and Benton R. Hunter (a2)

Abstract

Objectives

Intravenous dextrose aids in the resolution of ketosis in dehydrated patients not tolerating oral glucose and is often recommended in this clinical scenario. Our aim was to determine whether the addition of dextrose to intravenous rehydration solutions results in decreased hospital admissions or other clinically important benefits among dehydrated children or adults.

Methods

MEDLINE, EMBASE, Web of Science, SCOPUS, and the Cochrane Library were searched by a medical librarian from inception through November 2017. The inclusion criteria were randomized controlled trials comparing dextrose containing intravenous solutions with intravenous solutions without dextrose in patients being treated for dehydration, and not already hospitalized.

Results

The database and bibliographies search identified 1,472 unique citations. Only two trials (N = 333) met the inclusion criteria. Both compared normal saline with solutions of dextrose in normal saline. There was no statistically significant difference in admission rates (relative risk = 0.83; 95% confidence interval = 0.62 to 1.10) or revisits (relative risk = 0.54; 95% confidence interval = 0.24 to 1.22). Heterogeneity was low (I2 = 0). No other outcome results were eligible for pooling, but neither study found differences in any clinical outcomes. No adverse events were reported in either trial.

Conclusions

The addition of dextrose to intravenous saline has not been shown to improve clinical outcomes in dehydrated children presenting to the emergency department with gastroenteritis, but the confidence intervals around the estimate of effect are wide and include the possibility of substantial benefit.

Objectif

Les perfusions de dextrose aident à neutraliser la cétose chez les patients en état de déshydratation qui ne tolèrent pas la prise orale de glucose, et le traitement est souvent recommandé dans ces situations cliniques. L’étude visait donc à déterminer si l'adjonction de dextrose aux solutions de réhydratation intraveineuse se traduisait par une réduction du nombre d'hospitalisations ou offrait d'autres avantages cliniques importants chez les enfants et les adultes.

Méthode

Une recherche a été menée dans les bases de données MEDLINE, EMBASE, SCOPUS, la plateforme Web of Science et la bibliothèque Cochrane Library par un bibliothécaire spécialisé dans le domaine médical, depuis leur mise sur pied jusqu’à novembre 2017. Les critères de sélection consistaient en la recherche d'essais à répartition aléatoire, dans lesquels étaient comparées des solutions de perfusion additionnées de dextrose à celles n'en contenant pas chez les patients externes, traités pour de la déshydratation.

Résultats

La recherche documentaire dans les bibliographies et les bases de données a permis de relever 1472 citations uniques; toutefois, 2 essais (n = 333) seulement satisfaisaient aux critères de sélection. Dans les deux cas, on comparait des solutions physiologiques salées à des solutions physiologiques salées additionnées de dextrose. Il n'est ressorti aucun écart significatif en ce qui concerne le taux d'hospitalisation (taux relatif [TR] = 0,83; intervalle de confiance [IC] à 95% = 0,62–1,10) ou de reconsultation (TR = 0,54; IC à 95% = 0,24–1,22). Quant à l'hétérogénéité, elle était faible (I2 = 0). Aucun autre résultat ne se prêtait à une mise en commun, mais il ne s'est pas dégagé non plus de différence entre les deux études à l’égard de quelque résultat clinique que ce soit. Enfin, aucun événement indésirable n'a été signalé dans l'un ou l'autre des essais.

Conclusion

L'adjonction de dextrose aux solutions physiologiques salées ne s'est pas traduite par une amélioration des résultats cliniques chez les enfants en état de déshydratation, traités au service des urgences pour une gastroentérite; toutefois, les intervalles de confiance entourant l'estimation des effets sont larges et pourraient comporter des avantages importants.

Copyright

Corresponding author

Correspondence to: Dr. Benton R. Hunter, Indiana University School of Medicine, Department of Emergency Medicine, 1701 N. Senate Ave., Indianapolis, IN 46202; Email: brhunter@iu.edu

References

Hide All
1.Gindi, RM, Jones, LI. Reasons for emergency room use among U.S. children: National Health Interview Survey, 2012. NCHS Data Brief 2014(160):1-8.
2.National Collaborating Centre for Women's and Children's Health. National Institute for Health and Clinical Excellence: guidance. Diarrhoea and vomiting caused by gastroenteritis: diagnosis, assessment and management in children younger than 5 years. London: RCOG Press National Collaborating Centre for Women's and Children's Health; 2009.
3.Schappert, SM, Burt, CW. Ambulatory care visits to physician offices, hospital outpatient departments, and emergency departments: United States, 2001–02. Vital Health Stat 13 2006(159):1-66.
4.Better, OS. Impaired fluid and electrolyte balance in hot climates. Kidney Int Suppl 1987;21:S97-101.
5.Reid, SR, Losek, JD. Rehydration: role for early use of intravenous dextrose. Pediatr Emerg Care 2009;25(1):49-52, quiz 3–4.
6.Elliott, EJ. Acute gastroenteritis in children. BMJ 2007;334(7583):35-40.
7. Farthing, M, Salam, MA, Lindberg, G, et al. : Acute diarrhea in adults and children: a global perspective. J Clin Gastroenterol 2013;47(1):12-20.
8.King, CK, Glass, R, Bresee, JS, Duggan, C. Managing acute gastroenteritis among children: oral rehydration, maintenance, and nutritional therapy. MMWR Recomm Rep 2003;52(Rr-16):1-16.
9.Conners, GP, Barker, WH, Mushlin, AI, Goepp, JG. Oral versus intravenous: rehydration preferences of pediatric emergency medicine fellowship directors. Pediatr Emerg Care 2000;16(5):335-8.
10.Reid, SR, Bonadio, WA. Outpatient rapid intravenous rehydration to correct dehydration and resolve vomiting in children with acute gastroenteritis. Ann Emerg Med 1996;28(3):318-23.
11.Simpson, JN, Teach, SJ. Pediatric rapid fluid resuscitation. Curr Opin Pediatr 2011;23(3):286-92.
12.Levy, JA, Bachur, RG. Intravenous dextrose during outpatient rehydration in pediatric gastroenteritis. Acad Emerg Med 2007;14(4):324-30.
13.Toth, HL, Greenbaum, LA. Severe acidosis caused by starvation and stress. Am J Kidney Dis 2003;42(5):E16-9.
14.Colletti, JE, Brown, KM, Sharieff, GQ, et al. The management of children with gastroenteritis and dehydration in the emergency department. J Emerg Med 2010;38(5):686-98.
15.Bai, K, Fu, Y, Liu, C, et al. Pediatric non-diabetic ketoacidosis: a case-series report. BMC Pediatr 2017;17(1):209.
16.Owen, OE, Caprio, S, Reichard, GA Jr., et al. Ketosis of starvation: a revisit and new perspectives. Clin Endocrinol Metab 1983;12(2):359-79.
17.Higgins, JP, Altman, DG, Gotzsche, PC, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928.
18.Levy, JA, Bachur, RG, Monuteaux, MC, Waltzman, M. Intravenous dextrose for children with gastroenteritis and dehydration: a double-blind randomized controlled trial. Ann Emerg Med 2013;61(3):281-8.
19.Sendarrubias, M, Carron, M, Molina, JC, et al. Clinical impact of rapid intravenous rehydration with dextrose serum in children with acute gastroenteritis. Pediatr Emerg Care 2018;34(12):832-36.
20.Gorelick, MH, Shaw, KN, Murphy, KO. Validity and reliability of clinical signs in the diagnosis of dehydration in children. Pediatrics 1997;99(5):E6.
21.Akech, SO, Karisa, J, Nakamya, P, et al. Phase II trial of isotonic fluid resuscitation in Kenyan children with severe malnutrition and hypovolaemia. BMC Pediatr 2010;10:71.
22.Gutman, RA, Drutz, DJ, Whalen, GE Jr, Watten, RH. Double blind fluid therapy evaluation in pediatric cholera. Pediatrics 1969;44(6):922-31.
23.Juca, CA, Rey, LC, Martins, CV. Comparison between normal saline and a polyelectrolyte solution for fluid resuscitation in severely dehydrated infants with acute diarrhoea. Ann Trop Paediatr 2005;25(4):253-60.
24.Mahalanabis, D, Brayton, JB, Mondal, A, Pierce, NF. The use of Ringer's lactate in the treatment of children with cholera and acute noncholera diarrhoea. Bull World Health Organ 1972;46(3):311-9.
25.Rahaman, MM, Majid, MA, Monsur, KA. Evaluation of two intravenous rehydration solutions in cholera and non-cholera diarrhoea. Bull World Health Organ 1979;57(6):977-81.
26.Rahman, O, Bennish, ML, Alam, AN, Salam, MA. Rapid intravenous rehydration by means of a single polyelectrolyte solution with or without dextrose. J Pediatr 1988;113(4):654-60.
27.Tan, PC, Norazilah, MJ, Omar, SZ. Dextrose saline compared with normal saline rehydration of hyperemesis gravidarum: a randomized controlled trial. Obstet Gynecol 2013;121(2 Pt 1):291-8.

Keywords

Type Description Title
WORD
Supplementary materials

Grigsby et al. supplementary material
Appendix

 Word (20 KB)
20 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed