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Initial fluid management of diabetic ketoacidosis in children.
Am J Emerg Med. 2000 Oct; 18(6):658-60.AJ

Abstract

The purpose of this study was to review the emergency department management of children presenting in diabetic ketoacidosis (DKA) to determine if current recommendations for fluid therapy are practiced. A 5-year retrospective chart review was conducted of all pediatric patients admitted with DKA to the University of Alberta Hospital. Presenting clinical and laboratory data, the initial fluid therapy, and insulin dose were analyzed. The therapy was also compared between sites of initial presentation (primary, secondary, or tertiary hospital). A total of 49 cases of DKA in 37 patients were reviewed. There were no significant clinical or biochemical differences between patients presenting at the three levels of hospital. Forty-one cases (84%) were given a saline bolus and the mean fluid volume given by 1 hour was 18.3 mL/kg. In the first hour 82% of patients presenting at a primary or secondary centre and 67% of those at the tertiary centre received more than 10 mL/kg. This excessive fluid therapy was also evident after 4 hours. Fluid management of children in DKA is excessive and not in keeping with current recommendations. Education of emergency physicians is needed to reduce fluid therapy and the risk of neurologic complications.

Authors+Show Affiliations

Department of Pediatrics, University of Alberta, Edmonton, Canada.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

11043616

Citation

Rutledge, J, and R Couch. "Initial Fluid Management of Diabetic Ketoacidosis in Children." The American Journal of Emergency Medicine, vol. 18, no. 6, 2000, pp. 658-60.
Rutledge J, Couch R. Initial fluid management of diabetic ketoacidosis in children. Am J Emerg Med. 2000;18(6):658-60.
Rutledge, J., & Couch, R. (2000). Initial fluid management of diabetic ketoacidosis in children. The American Journal of Emergency Medicine, 18(6), 658-60.
Rutledge J, Couch R. Initial Fluid Management of Diabetic Ketoacidosis in Children. Am J Emerg Med. 2000;18(6):658-60. PubMed PMID: 11043616.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Initial fluid management of diabetic ketoacidosis in children. AU - Rutledge,J, AU - Couch,R, PY - 2000/10/24/pubmed PY - 2001/2/28/medline PY - 2000/10/24/entrez SP - 658 EP - 60 JF - The American journal of emergency medicine JO - Am J Emerg Med VL - 18 IS - 6 N2 - The purpose of this study was to review the emergency department management of children presenting in diabetic ketoacidosis (DKA) to determine if current recommendations for fluid therapy are practiced. A 5-year retrospective chart review was conducted of all pediatric patients admitted with DKA to the University of Alberta Hospital. Presenting clinical and laboratory data, the initial fluid therapy, and insulin dose were analyzed. The therapy was also compared between sites of initial presentation (primary, secondary, or tertiary hospital). A total of 49 cases of DKA in 37 patients were reviewed. There were no significant clinical or biochemical differences between patients presenting at the three levels of hospital. Forty-one cases (84%) were given a saline bolus and the mean fluid volume given by 1 hour was 18.3 mL/kg. In the first hour 82% of patients presenting at a primary or secondary centre and 67% of those at the tertiary centre received more than 10 mL/kg. This excessive fluid therapy was also evident after 4 hours. Fluid management of children in DKA is excessive and not in keeping with current recommendations. Education of emergency physicians is needed to reduce fluid therapy and the risk of neurologic complications. SN - 0735-6757 UR - https://www.unboundmedicine.com/medline/citation/11043616/Initial_fluid_management_of_diabetic_ketoacidosis_in_children_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-6757(00)91274-9 DB - PRIME DP - Unbound Medicine ER -