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Intravenous fluid bolus rates and pediatric diabetic ketoacidosis resolution
Louis Gordon Pruitt1, Glenn Jones1, Mandi Musso1
1Louisiana State University Health Sciences Center, Department of Emergency Medicine, 5246 Brittany Drive, Baton Rouge, LA 70808, United States of America.
Insights
Rapid fluid administration in pediatric diabetic ketoacidosis (DKA) may be beneficial. A study found no significant difference in outcomes for children with DKA receiving larger initial fluid boluses compared to smaller ones.
Area of Science:
- Pediatric Emergency Medicine
- Endocrinology
- Critical Care
Background:
- Emerging data challenge the traditional view that rapid intravenous fluid administration causes adverse neurologic outcomes in children with diabetic ketoacidosis (DKA).
- Many clinicians still use a conservative 10 cc/kg intravenous fluid bolus for pediatric DKA patients, despite potential benefits of larger boluses.
Purpose of the Study:
- To evaluate the impact of initial intravenous fluid bolus size on hospital length-of-stay and time to bicarbonate normalization in pediatric DKA patients.
- To compare outcomes between pediatric DKA patients receiving ≤10 cc/kg versus >10 cc/kg of fluids in the emergency department.
Main Methods:
- Retrospective chart review of pediatric patients diagnosed with DKA between 2013 and 2015.
- Comparison of patients who received ≤10 cc/kg fluid bolus versus >10 cc/kg in the emergency department.
- Primary outcome: hospital length-of-stay. Secondary outcome: time to bicarbonate normalization.
Main Results:
- Analysis included 170 pediatric DKA emergency department visits.
- Patients receiving ≤10 cc/kg bolus had a mean hospital stay 0.38 days longer, though this was not statistically significant after multivariable regression.
- Time to bicarbonate normalization was slightly longer (0.12 days) in the ≤10 cc/kg group, but this difference was not statistically significant.
Conclusions:
- After adjusting for confounders, initial intravenous fluid bolus size (≤10 cc/kg vs. >10 cc/kg) did not significantly impact hospital length-of-stay or time to bicarbonate normalization in pediatric DKA patients.
- These findings suggest that larger initial fluid boluses may be safe and potentially beneficial in managing pediatric DKA.
Background:
Recent data have challenged the notion that rapid intravenous fluid administration results in adverse neurologic outcomes in children with diabetic ketoacidosis (DKA). While many physicians still administer a cautious 10 cc/kg bolus of intravenous fluids for pediatric DKA patients, there may be benefits to using a larger bolus.
Methods:
This was a retrospective chart review of all pediatric patients with DKA presenting to a single emergency department (ED) between 2013 and 2015. Patients who received a bolus of 10 cc/kg or less in the ED were compared to patients who received >10 cc/kg of fluids. The primary outcome was the difference in hospital length-of-stay between the two groups. Secondarily, we compared groups with regards to the time to bicarbonate normalization.
Results:
In sum, 170 pediatric DKA ED visits were analyzed. Patients who received a 10 cc/kg bolus or less of fluids in the ED had a mean hospital length-of-stay > that was 0.38 days longer (95% CI: 0.006 to 0.75 days) than those who received >10 cc/kg. On multivariable regression analysis, the difference between groups was diminished and no longer statistically significant. The time to bicarbonate normalization was 0.12 days longer (95% CI -0.029 to 0.27) in the 10 cc/kg or less group than the >10 cc/kg group.
Conclusions:
After adjustment for confounders, no statistically significant differences in outcomes were seen in pediatric DKA patients who received a 10 cc/kg bolus or less compared to those who received a larger initial bolus.
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