Volume : 12, Issue : 09, September – 2025
Title:
FLUID RESUSCITATION IN PAEDIATRIC DKA: CONSERVATIVE VS. AGGRESSIVE STRATEGIES – A NARRATIVE STUDY OF PRACTICE AND CHALLENGES
Authors :
Dr Sadaf Aftab, Dr. Muhammad Fahad Khaliq, Dr. Maheen Khaliq
Abstract :
Background: Diabetic ketoacidosis (DKA) is amongst the most severe acute complications of type 1 diabetes mellitus in children. Fluid resuscitation is a cornerstone treatment but evokes continued controversy over the best strategy.
Objective: In this study, the latest evidence on comparison of aggressive vs conservative fluid resuscitation regimens in pediatric DKA is analyzed for efficacy, safety, and related risks.
Methods: A narrative study of randomized controlled trials (RCTs), observational studies, and consensus guidelines published from 2010–2024 was done. Important outcomes between the two were comparison of acidosis resolution, neurological complications, and mortality.
Results: Conservative regimens were as effective in normalizing metabolic derangements with less risk of cerebral edema, and aggressive regimens resulted in faster biochemical resolution at the expense of the blood bank.
Conclusion: Fluid resuscitation should be a logical and individualized plan, adjusted according to severity, blood hemodynamic status, and risk of complications.
Keywords: Pediatric DKA, fluid resuscitation, cerebral edema, aggressive therapy, conservative therapy
Cite This Article:
Please cite this article in press Sadaf Aftab et al., Fluid Resuscitation In Paediatric DKA: Conservative vs. Aggressive strategies – a Narrative Study Of Practice And Challenges, Indo Am. J. P. Sci, 2025; 12(09).
REFERENCES:
1. Mourid, M. R., Oboli, V. N., Gill, P., Pyala, R., AlishahZehra, S., Gamboa, L. L., & Alsabri, M. (2025). Managing Neurological Complications in Pediatric Diabetic Ketoacidosis: Insights from Low-Resource Emergency Departments and Comparisons with High-Resource Settings: A Narrative Review. Current Treatment Options in Pediatrics, 11(1), 14.
2. Mohammed, M. S., Sliders, E., Alakkad, A. G., Ahmed, O. A. R., & Saleh, M. M. E. (2025). Precision Fluid Management in a Severe DKA Patient with Complicated Acute Pancreatitis: Reducing Mortality and Length of ICU Stay. Archives of Anesthesiology and Critical Care.
3. Yared, G., Madi, N., Barakat, H., El Hajjar, C., Al Hassan, J., Nakib, H., & Ghazal, K. (2024). Uterine sacrifice in obstetric emergencies case series: Complex cases of fetal distress, labor challenges, and life-saving interventions. SAGE Open Medical Case Reports, 12, 2050313X241261487.
4. Kalentakis, Z., Garifallos, N., Baxevani, G., Panagiotou, K., Spanos, E., Vlastos, I., & Karkas, A. (2025). Orbital Complications of Chronic Rhinosinusitis: A Contemporary Narrative Review of the Ophthalmologic Impact and Therapeutic Role of Functional Endoscopic Sinus Surgery. Sinusitis, 9(2), 18.
5. Gil, S. M., Aziz, M., De Dona, V., Lopez, L., Florencia Soto, M., Ayarzabal, V., … & Viterbo, G. (2024). Surgical treatment of secondary hyperparathyroidism in children with chronic kidney disease. Experience in 19 patients. Journal of Pediatric Endocrinology and Metabolism, 37(4), 353-359.
6. Nair, S. C., Al-Neyadi, A. M., Al-Mazrouei, R. A., Jamil, G. A., Al-Qawasmeh, K. H., Al-Kuwaiti, A. H., … & Al Dahmani, K. M. (2024). Free Communications of the Seventh Annual Al Ain Research Day, Al Ain, United Arab Emirates, June 9, 2023. Ibnosina Journal of Medicine and Biomedical Sciences, 16(01), A1-A36.
7. Nguyen, H. T. (2024). Evaluate the efficacy of plasmapheresis therapy in patient with hypertriglyceridemia-induced pancreatitis in108 Military Central Hospital from January 2016 to January 2023 (Master’s thesis).
8. Saeed, Z. I., Akturk, H. K., Aleppo, G., Kruger, D., Levy, C. J., Mader, J. K., … & Shah, V. N. (2025). Insulin Titration Recommendations When Using Glucagon-Like Peptide 1 Receptor Agonist Therapy in Adults With Type 1 Diabetes. Clinical Diabetes, 43(1).
9. Giovanella, L., Tuncel, M., Campennì, A., Ruggeri, R. M., Huellner, M., & Petranović Ovčariček, P. (2025). Endocrine Adverse Events Induced by Cancer Treatments: The Role of 18F-Fluorodeoxyglucose Positron Emission Tomography. Cancers, 17(16), 2651.
10. Carsote, M., Nistor, C., Gheorghe, A. M., Sima, O. C., Trandafir, A. I., Nistor, T. V. I., … & Ciobica, M. L. (2024). Turning Points in Cross-Disciplinary Perspective of Primary Hyperparathyroidism and Pancreas Involvements: Hypercalcemia-Induced Pancreatitis, MEN1 Gene-Related Tumors, and Insulin Resistance. International Journal of Molecular Sciences, 25(12), 6349.
11. Veseli, E., Mehrabanian, M., & Ammar, N. (2025). The potential of artificial intelligence in the early detection of systemic diseases during routine dental care: The potential of artificial intelligence in the early detection of systemic diseases during routine dental care. British Dental Journal, 239(3), 168-174.
12. Hamdani, T. M. (2025). Narratives of Identity: Indonesian Cinema and the Journey to Global Recognition. In Global Development of Asian Cinema in the Film Industry (pp. 55-82). IGI Global Scientific Publishing.
13. Blank, S. P., Blank, R. M., Laupland, K. B., Tabah, A., Gill, D., Kumar, A., … & Ramanan, M. (2025). Queensland Critical Care Research Network (QCCRN). Sodium bicarbonate administration for metabolic acidosis in the intensive care unit: a target trial emulation. Intensive Care Med, 51(6), 1-9.
14. Alnajadah, A. Too close or not enough? The refinement of the Citizen Satisfaction Index (CSI) in place brands: a comparison of the significance of personal factors between Kuwait City and London (Doctoral dissertation, 88wwz).
15. Aleksandrovich, Y. S., Prometnoy, D. V., Petryaykina, E. E., Kiyaev, A. V., Peterkova, V. A., Kopylov, V. V., … & Alyokhina, A. A. Diagnosis and Intensive Care in Children’s Diabetic Acidosis: an Interdisciplinary Viewpoint. GENERAL REANIMATOLOGY, 40.
16. Berman, R., Heyworth, B., & Ahamed, A. (Eds.). (2025). The UK Association of Supportive Care in Cancer Handbook of Supportive Oncology. CRC Press.
17. Tallarico, R. T., Jing, B., Lu, K., Chawla, S. A., Luo, Y., Badathala, A., … & Legrand, M. (2025). Postoperative Outcomes Among Sodium-Glucose Cotransporter 2 Inhibitor Users. JAMA surgery, 160(6), 681-689.
18. Praschan, N., Beach, S. R., Fricchione, G. L., Huffman, J. C., & Stern, T. A. (2024). 38 Catatonia, Neuroleptic Malignant Syndrome, and Serotonin Syndrome. Massachusetts General Hospital Comprehensive Clinical Psychiatry-E-BOOK, 424.