Impact of resuscitation fluids in the pediatric emergency department on length of stay, electrolyte balance, and kidney function.

The optimal resuscitation fluid in pediatric emergency departments remains unresolved. Balanced solutions, such as Ringer's lactate, have emerged as alternatives to the long-standing use of normal saline; however, existing studies have not demonstrated significant differences in clinical outcomes. This study aimed to assess the clinical impact of transitioning from normal saline to Ringer's lactate solution in the pediatric emergency department, primarily in terms of length of hospital stay, alongside kidney functions and biochemical measures. We conducted a prospective study comparing clinical outcomes of a transition from normal saline to Ringer's lactate for resuscitation boluses. Each of the two study groups included 107 pediatric patients. A mean of 42 mL/kg was administered as a fluid bolus in the normal saline and Ringer's lactate groups (42.04 vs 42.1 mL/kg respectively). The most common diagnosis was fluid losses, followed by sepsis (81% vs 83% and 13% vs 11% respectively). Notably, the length of stay was significantly shorter in the Ringer's lactate group (2.6 days) compared to the normal saline group (3.4 days). No significant differences were observed in acid-base balance, electrolyte levels, or kidney function indicators. These findings were consistent among a subset of patients with acute kidney injury at admission.

conclusionsThe use of Ringer's lactate resulted in a shorter length of hospital stay, with implications for both medical care and healthcare costs. No other significant differences were identified between the two fluid solutions. WHAT IS KNOWN: • Fluid boluses are the mainstay of treating children with signs of shock. The use of balanced fluids has not shown an advantage relating to morbidity or mortality. Most pediatric emergency departments use normal saline as a standard, while intensive care units shift to balanced solutions. WHAT IS NEW: • Using a balanced solution as the fluid of choice for boluses in a pediatric emergency department was feasible and showed a streamlined fluid treatment. The use of a balanced solution from emergency department presentation was associated with a shorter length of stay.