Authors´ conclusions: the evidence is very uncertain about the effect of balanced solutions on mortality during hospitalization in severely dehydrated children. However, they likely result in a slight reduction of the time in the hospital compared to 0.9% saline. Also, balanced solutions likely reduce the risk of hypokalemia after intravenous correction. Furthermore, the evidence suggests that balanced solutions compared to 0.9% saline probably produce no changes in the need for additional intravenous fluids or in other biochemical measures such as sodium, chloride, potassium, and creatinine levels. Last, there may be no difference in the incidence of hyponatremia.
Reviewers´ commentary: the use of balanced solutions compared to 0.9% saline solution seems to slightly reduce the time in the hospital, as well as achieve higher pH and bicarbonate levels, without showing differences in terms of mortality or the appearance of renal failure in severe dehydration due to acute diarrhea. In our setting, balance solutions are available, so their use should be assessed; in low-income countries, their availability should be taken into account when recommending them.