Crystalloid fluid choices and their impact on acute kidney injury and other outcomes in pediatric sepsis a prospective study in Ecuador

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Introduction: Sepsis and septic shock are significant causes of morbidity and mortality in pediatric patients, with fluid resuscitation being a critical intervention. This study compares the effects of 0.9% saline solution and Ringer Lactate on acute kidney injury (AKI), metabolic acidosis, and overall outcomes in pediatric sepsis. Objective: To evaluate the association between fluid type and the incidence of AKI, metabolic acidosis, and mortality in pediatric patients with sepsis or septic shock. Methods: A prospective observational study was conducted from January to November 2023 at Hospital Padre Carollo "Un Canto a la Vida" in Quito, Ecuador. Thirty-five children aged 1 month to 179 months with sepsis or septic shock were included. Patients received either 0.9% saline or Ringer Lactate based on clinician judgment. Primary outcomes were the incidence of AKI and metabolic acidosis. Secondary outcomes included mortality and length of stay. Logistic regressions were performed to assess outcomes. Results: The incidence of AKI was significantly higher in the saline group (30%) compared to the Ringer Lactate group (13.3%) (p=0.045). Metabolic acidosis was also more common in the saline group (25% vs. 6.7%; p=0.037). Mortality did not differ significantly between groups (5% in saline vs. 0% in Ringer Lactate; p=0.325). The median ICU length of stay was 12 days for saline and 10 days for Ringer Lactate (p=0.356). Conclusions: Ringer Lactate is associated with a lower incidence of AKI and metabolic acidosis compared to 0.9% saline in pediatric sepsis patients. These findings suggest that balanced crystalloids may offer safer outcomes for fluid resuscitation in this population.