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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
CLINICIAN'S CAPSULE

What is known about the topic?

Intravenous dextrose halts endogenous ketone production and is commonly recommended in dehydrated patients unable to tolerate oral intake.

What did this study ask?

Is there evidence that the addition of dextrose to intravenous fluids provides a clinically meaningful benefit in dehydrated patients?

What did this study find?

Intravenous dextrose has not been shown to provide any important benefit to patients in this setting, but further research is needed.

Why does this study matter to clinicians?

In dehydrated patients, clinicians should not feel obligated towards dextrose containing solutions, which may be more expensive and less readily available.

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
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Canadian Journal of Emergency Medicine
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