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An evaluation of the outside therapy of diabetic ketoacidosis in pediatric patients.
Am J Ther. 2008 Nov-Dec; 15(6):516-9.AJ

Abstract

BACKGROUND

Despite literature outlining suggested initial therapy for pediatric patients with diabetic ketoacidosis (DKA), our impression has been that there may be variations from these recommendations during the initial therapy of pediatric patients with DKA. In order to improve education initiatives, an understanding of the deviations from current practice is required.

METHODS

Patients admitted to the pediatric intensive care unit with a diagnosis of DKA were identified from the admission log. The pre-pediatric intensive care unit care including laboratory evaluation, insulin dosing, and fluid therapy was recorded.

RESULTS

The study cohort included 135 episodes of DKA in 127 patients (age range: 10 months to 21 years). A complete blood count was obtained in 83.7% of the patients. Serum electrolytes, blood urea nitrogen, and creatinine were obtained in 89.6%, and a serum pH was obtained in 58%. Seventy-two patients received a bolus dose of insulin. The insulin bolus was < or =0.05 units/kg in 1 patient, >0.05 to < or =0.1 units/kg in 13 patients, >0.1 to < or =0.2 units/kg in 27 patients, and >0.2 units/kg in 31 patients. The route of administration for the insulin bolus was intravenous (IV) in 58 patients, a combination of IV and subcutaneous in 7 patients, subcutaneous in 6, and a combination of intramuscular and IV in 1 patient. Fluid administered before transport ranged from 0 to 60.6 mL/kg. Sixteen patients did not receive a fluid bolus. Normal saline was used in 115 patients, Ringer's lactate solution in 3, and 5% glucose in (1/2) normal saline in 1. Seventeen patients (12.6%) received IV sodium bicarbonate.

CONCLUSIONS

Major issues with the prehospital care of children and adolescents with DKA included lack of appropriate laboratory evaluation, excessive insulin dosing (both bolus doses and infusion rates), lack of fluid resuscitation, use of inappropriate fluids for resuscitation, and the use of sodium bicarbonate.

Authors+Show Affiliations

School of Medicine, University of Missouri, Columbia, MO, USA.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19127134

Citation

Bradley, Paul, and Joseph D. Tobias. "An Evaluation of the Outside Therapy of Diabetic Ketoacidosis in Pediatric Patients." American Journal of Therapeutics, vol. 15, no. 6, 2008, pp. 516-9.
Bradley P, Tobias JD. An evaluation of the outside therapy of diabetic ketoacidosis in pediatric patients. Am J Ther. 2008;15(6):516-9.
Bradley, P., & Tobias, J. D. (2008). An evaluation of the outside therapy of diabetic ketoacidosis in pediatric patients. American Journal of Therapeutics, 15(6), 516-9. https://doi.org/10.1097/MJT.0b013e318172771b
Bradley P, Tobias JD. An Evaluation of the Outside Therapy of Diabetic Ketoacidosis in Pediatric Patients. Am J Ther. 2008 Nov-Dec;15(6):516-9. PubMed PMID: 19127134.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - An evaluation of the outside therapy of diabetic ketoacidosis in pediatric patients. AU - Bradley,Paul, AU - Tobias,Joseph D, PY - 2009/1/8/entrez PY - 2009/1/8/pubmed PY - 2009/3/10/medline SP - 516 EP - 9 JF - American journal of therapeutics JO - Am J Ther VL - 15 IS - 6 N2 - BACKGROUND: Despite literature outlining suggested initial therapy for pediatric patients with diabetic ketoacidosis (DKA), our impression has been that there may be variations from these recommendations during the initial therapy of pediatric patients with DKA. In order to improve education initiatives, an understanding of the deviations from current practice is required. METHODS: Patients admitted to the pediatric intensive care unit with a diagnosis of DKA were identified from the admission log. The pre-pediatric intensive care unit care including laboratory evaluation, insulin dosing, and fluid therapy was recorded. RESULTS: The study cohort included 135 episodes of DKA in 127 patients (age range: 10 months to 21 years). A complete blood count was obtained in 83.7% of the patients. Serum electrolytes, blood urea nitrogen, and creatinine were obtained in 89.6%, and a serum pH was obtained in 58%. Seventy-two patients received a bolus dose of insulin. The insulin bolus was < or =0.05 units/kg in 1 patient, >0.05 to < or =0.1 units/kg in 13 patients, >0.1 to < or =0.2 units/kg in 27 patients, and >0.2 units/kg in 31 patients. The route of administration for the insulin bolus was intravenous (IV) in 58 patients, a combination of IV and subcutaneous in 7 patients, subcutaneous in 6, and a combination of intramuscular and IV in 1 patient. Fluid administered before transport ranged from 0 to 60.6 mL/kg. Sixteen patients did not receive a fluid bolus. Normal saline was used in 115 patients, Ringer's lactate solution in 3, and 5% glucose in (1/2) normal saline in 1. Seventeen patients (12.6%) received IV sodium bicarbonate. CONCLUSIONS: Major issues with the prehospital care of children and adolescents with DKA included lack of appropriate laboratory evaluation, excessive insulin dosing (both bolus doses and infusion rates), lack of fluid resuscitation, use of inappropriate fluids for resuscitation, and the use of sodium bicarbonate. SN - 1536-3686 UR - https://www.unboundmedicine.com/medline/citation/19127134/An_evaluation_of_the_outside_therapy_of_diabetic_ketoacidosis_in_pediatric_patients_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&amp;PAGE=linkout&amp;SEARCH=19127134.ui DB - PRIME DP - Unbound Medicine ER -