Effect of Volume of Fluid Resuscitation on Metabolic Normalization in Children Presenting in Diabetic Ketoacidosis: A Randomized Controlled Trial

The Journal of Emergency Medicine
Katherine BakesArleta Rewers

Abstract

The optimal rate of fluid administration in pediatric diabetic ketoacidosis (DKA) is unknown. Our aim was to determine whether the volume of fluid administration in children with DKA influences the rate of metabolic normalization. We performed a randomized controlled trial conducted in a tertiary pediatric emergency department from December 2007 until June 2010. The primary outcome was time to metabolic normalization; secondary outcomes were time to bicarbonate normalization, pH normalization, overall length of hospital treatment, and adverse outcomes. Children between 0 and 18 years of age were eligible if they had type 1 diabetes mellitus and DKA. Patients were randomized to receive intravenous (IV) fluid at low volume (10 mL/kg bolus + 1.25 × maintenance rate) or high volume (20 mL/kg bolus + 1.5 × maintenance rate) (n = 25 in each). After adjusting for initial differences in bicarbonate levels, time to metabolic normalization was significantly faster in the higher-volume infusion group compared to the low-volume infusion group (hazard ratio [HR] = 2.0; 95% confidence interval [CI] 1.0-3.9; p = 0.04). Higher-volume IV fluid infusion appeared to hasten, to a greater extent, normalization of pH (HR = 2.5; 95% CI 1.2-5.0; p = 0...Continue Reading

Associated Clinical Trials

Apr 25, 2017·Petter Bjornstad

References

Oct 24, 2000·The American Journal of Emergency Medicine·J Rutledge, R Couch
Aug 4, 2004·The Journal of Pediatrics·Nicole S GlaserNathan Kuppermann
Jun 23, 2007·BMJ : British Medical Journal·Ketan K Dhatariya
Jul 16, 2008·Clinical Pediatrics·Michele J FaganHnin Khine
Mar 26, 2010·Annals of Internal Medicine·Kenneth F SchulzUNKNOWN CONSORT Group
Oct 8, 2011·Diabetes Research and Clinical Practice·Ebenezer A Nyenwe, Abbas E Kitabchi
Jun 12, 2013·Journal of Intensive Care Medicine·Sangita BasnetJanak Koirala

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Citations

Dec 19, 2019·The Nurse Practitioner·Mohamed Toufic El Hussein, Lauren Kilfoil
Sep 29, 2020·Frontiers in Medicine·Todd S IngAntonios H Tzamaloukas
Feb 20, 2021·The Journal of Pediatric Pharmacology and Therapeutics : JPPT : the Official Journal of PPAG·Brady S MoffettBonnie McCann-Crosby
Jul 1, 2021·Diabetes Care·Arleta RewersUNKNOWN Pediatric Emergency Care Applied Research Network (PECARN) FLUID Study Group

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