Rehydration Rates and Outcomes in Overweight Children With Diabetic Ketoacidosis
Kathleen M Brown1, Nicole S Glaser2, Julie K McManemy3
1Division of Emergency Medicine, Department of Pediatrics, Children's National Medical Center, the George Washington School of Medicine and Health Sciences, Washington, District of Columbia.
Insights
Fluid resuscitation in obese children with diabetic ketoacidosis (DKA) is safe. Higher fluid rates did not increase the risk of cerebral injury or mental status changes in overweight or obese youth, suggesting current protocols can be followed.
Area of Science:
- Pediatric Emergency Medicine
- Endocrinology
- Critical Care
Background:
- The FLUID Trial indicated rapid fluid infusion is safe for diabetic ketoacidosis (DKA).
- Concerns exist regarding appropriate fluid rates for overweight or obese pediatric patients with DKA.
- This study analyzed the FLUID Trial database to assess fluid infusion rates in overweight/obese children with DKA.
Purpose of the Study:
- To evaluate the association between fluid infusion rates and outcomes in overweight and obese children with DKA.
- To compare outcomes in overweight, obese, and normal-weight children regarding fluid therapy in DKA.
Main Methods:
- Analysis of the FLUID Trial database.
- Comparison of protocol adherence, mental status changes, DKA resolution time, and electrolyte abnormalities between weight groups (overweight, obese, normal weight).
- Investigation of the relationship between fluid volume received and patient outcomes.
Main Results:
- Overweight and obese children were more likely to receive fluids at slower rates than protocol dictated.
- Children receiving fluids per protocol based on weight showed similar rates of mental status changes or cerebral injury, regardless of weight status.
- Increased risk of hypophosphatemia was linked to larger initial fluid boluses, while higher rehydration rates reduced this risk.
Conclusions:
- Physicians may be hesitant to use weight-based fluid calculations for overweight/obese children in DKA.
- Higher fluid infusion rates were not associated with increased risk of mental status changes or cerebral injury in obese children with DKA.
- Fluid resuscitation should not be limited in overweight or obese children and youth experiencing DKA.
Background And Objectives:
The Pediatric Emergency Care Applied Research Network Fluid Therapies Under Investigation in Diabetic Ketoacidosis (DKA) (FLUID) Trial found that rapid fluid infusion does not increase the risk of cerebral injury. Concern persists, however, whether fluid rates should be adjusted for overweight or obese patients. We used the FLUID Trial database to evaluate associations between fluid infusion rate and outcomes in these patients.
Methods:
We compared children and youth who were overweight, obese, or normal weight, in regard to protocol adherence, mental status changes, time to DKA resolution, and electrolyte abnormalities. We investigated associations between outcomes and the amount of fluid received in these groups.
Results:
Obese children and youth were more likely to receive fluids at rates slower than dictated by protocol. Overweight and obese children and youth in the fast fluid arms, who received fluids per the study protocol based on their measured weight, had similar rates of mental status changes or clinically apparent cerebral injury as those with normal weights. Risk of hypophosphatemia was increased in those receiving larger initial bolus volumes and reduced in those receiving higher rehydration rates. No other metabolic outcomes were associated with rehydration.
Conclusions:
Protocol adherence data in the FLUID Trial suggest that physicians are uncomfortable using weight-based fluid calculations for overweight or obese children. However, higher rates of fluid infusion were not associated with increased risk of mental status changes or cerebral injury, suggesting that physicians should not limit fluid resuscitation in obese children and youth with DKA.
Related Concept Videos
01:20Acute Kidney Injury V: Interprofessional Care
01:16Insulin: Dosing Regimen and Adverse Effects
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
01:22Acute Kidney Injury VI: Nursing Management
01:25Regulation of Water Intake
01:29Acute Kidney Injury III: Clinical Manifestations
01:36Carbohydrate Metabolism
Starch accounts for approximately 60% of the carbohydrates consumed by humans. Since amylase enzymes cannot function in the stomach's acidic environment, starch can only be digested in the mouth and small intestine. Simple sugars are found naturally in milk and fruits in...