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

Ashley Grigsby, Jennifer Herron, Benton R. Hunter

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)638-645
Number of pages8
JournalCanadian Journal of Emergency Medicine
Volume21
Issue number5
DOIs
StatePublished - Sep 1 2019

Fingerprint

Dehydration
Meta-Analysis
Glucose
Confidence Intervals
Therapeutics
Rehydration Solutions
Librarians
Ketosis
Gastroenteritis
Bibliography
crystalloid solutions
Sodium Chloride
MEDLINE
Libraries
Hospital Emergency Service
Randomized Controlled Trials
Databases

Keywords

  • dehydration
  • dextrose
  • intravenous fluids

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Does the addition of dextrose to IV crystalloid therapy provide clinical benefit in acute dehydration? A systematic review and meta-analysis. / Grigsby, Ashley; Herron, Jennifer; Hunter, Benton R.

In: Canadian Journal of Emergency Medicine, Vol. 21, No. 5, 01.09.2019, p. 638-645.

Research output: Contribution to journalArticle

@article{798c3c1eb89848c1a8adf7c46cf9bd9c,
title = "Does the addition of dextrose to IV crystalloid therapy provide clinical benefit in acute dehydration? A systematic review and meta-analysis",
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.",
keywords = "dehydration, dextrose, intravenous fluids",
author = "Ashley Grigsby and Jennifer Herron and Hunter, {Benton R.}",
year = "2019",
month = "9",
day = "1",
doi = "10.1017/cem.2018.500",
language = "English (US)",
volume = "21",
pages = "638--645",
journal = "Canadian Journal of Emergency Medicine",
issn = "1481-8035",
publisher = "BC Decker Inc.",
number = "5",

}

TY - JOUR

T1 - Does the addition of dextrose to IV crystalloid therapy provide clinical benefit in acute dehydration? A systematic review and meta-analysis

AU - Grigsby, Ashley

AU - Herron, Jennifer

AU - Hunter, Benton R.

PY - 2019/9/1

Y1 - 2019/9/1

N2 - 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.

AB - 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.

KW - dehydration

KW - dextrose

KW - intravenous fluids

UR - http://www.scopus.com/inward/record.url?scp=85072627956&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85072627956&partnerID=8YFLogxK

U2 - 10.1017/cem.2018.500

DO - 10.1017/cem.2018.500

M3 - Article

C2 - 30698123

AN - SCOPUS:85072627956

VL - 21

SP - 638

EP - 645

JO - Canadian Journal of Emergency Medicine

JF - Canadian Journal of Emergency Medicine

SN - 1481-8035

IS - 5

ER -