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Insulin infused at 0.05 versus 0.1 units/kg/hr in children admitted to intensive care with diabetic ketoacidosis.
Pediatr Crit Care Med. 2011 Mar; 12(2):137-40.PC

Abstract

OBJECTIVE

To compare the effects of infusing insulin at 0.05 units/kg/hr rather than 0.1 units/kg/hr in children admitted to the intensive care unit with diabetic ketoacidosis.

DESIGN

A retrospective observational study.

SETTING

A tertiary pediatric intensive care unit.

PATIENTS

All children with diabetic ketoacidosis admitted during the 6-yr period from 2000 to 2005.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

The effective plasma osmolality (plasma glucose concentration in mmol/L + twice the plasma sodium concentration in mmol/L), plasma glucose, plasma sodium, fluid intake, and acid-base status 12 hrs after the commencement of the insulin infusion. Compared to the 34 children who received 0.1 units/kg/hr of insulin, the 33 children who received 0.05 units/kg/hr of insulin were younger (median age, 25 mos vs. 62 mos, p = .024) and had a more gradual reduction in the effective plasma osmolality over the first 12 hrs (p < .0005); this was because plasma glucose decreased more slowly (p = .004) and plasma sodium increased faster (p < .0005). Both groups had a satisfactory improvement in acidosis and ketosis, and they had a similar length of stay in the intensive care unit.

CONCLUSIONS

Further studies are needed to evaluate the role of using 0.05 units/kg/hr of insulin to treat children with diabetic ketoacidosis. The smaller dose of insulin may make it easier to lower the effective plasma osmolality gradually and might, therefore, reduce the risk of cerebral edema.

Authors+Show Affiliations

Pediatric Intensive Care Unit, The Royal Hospital, Sultanate of Oman.No affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

20473242

Citation

Al Hanshi, Said, and Frank Shann. "Insulin Infused at 0.05 Versus 0.1 Units/kg/hr in Children Admitted to Intensive Care With Diabetic Ketoacidosis." Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, vol. 12, no. 2, 2011, pp. 137-40.
Al Hanshi S, Shann F. Insulin infused at 0.05 versus 0.1 units/kg/hr in children admitted to intensive care with diabetic ketoacidosis. Pediatr Crit Care Med. 2011;12(2):137-40.
Al Hanshi, S., & Shann, F. (2011). Insulin infused at 0.05 versus 0.1 units/kg/hr in children admitted to intensive care with diabetic ketoacidosis. Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 12(2), 137-40. https://doi.org/10.1097/PCC.0b013e3181e2a21b
Al Hanshi S, Shann F. Insulin Infused at 0.05 Versus 0.1 Units/kg/hr in Children Admitted to Intensive Care With Diabetic Ketoacidosis. Pediatr Crit Care Med. 2011;12(2):137-40. PubMed PMID: 20473242.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Insulin infused at 0.05 versus 0.1 units/kg/hr in children admitted to intensive care with diabetic ketoacidosis. AU - Al Hanshi,Said, AU - Shann,Frank, PY - 2010/5/18/entrez PY - 2010/5/18/pubmed PY - 2011/10/6/medline SP - 137 EP - 40 JF - Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies JO - Pediatr Crit Care Med VL - 12 IS - 2 N2 - OBJECTIVE: To compare the effects of infusing insulin at 0.05 units/kg/hr rather than 0.1 units/kg/hr in children admitted to the intensive care unit with diabetic ketoacidosis. DESIGN: A retrospective observational study. SETTING: A tertiary pediatric intensive care unit. PATIENTS: All children with diabetic ketoacidosis admitted during the 6-yr period from 2000 to 2005. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The effective plasma osmolality (plasma glucose concentration in mmol/L + twice the plasma sodium concentration in mmol/L), plasma glucose, plasma sodium, fluid intake, and acid-base status 12 hrs after the commencement of the insulin infusion. Compared to the 34 children who received 0.1 units/kg/hr of insulin, the 33 children who received 0.05 units/kg/hr of insulin were younger (median age, 25 mos vs. 62 mos, p = .024) and had a more gradual reduction in the effective plasma osmolality over the first 12 hrs (p < .0005); this was because plasma glucose decreased more slowly (p = .004) and plasma sodium increased faster (p < .0005). Both groups had a satisfactory improvement in acidosis and ketosis, and they had a similar length of stay in the intensive care unit. CONCLUSIONS: Further studies are needed to evaluate the role of using 0.05 units/kg/hr of insulin to treat children with diabetic ketoacidosis. The smaller dose of insulin may make it easier to lower the effective plasma osmolality gradually and might, therefore, reduce the risk of cerebral edema. SN - 1529-7535 UR - https://www.unboundmedicine.com/medline/citation/20473242/Insulin_infused_at_0_05_versus_0_1_units/kg/hr_in_children_admitted_to_intensive_care_with_diabetic_ketoacidosis_ L2 - http://Insights.ovid.com/pubmed?pmid=20473242 DB - PRIME DP - Unbound Medicine ER -