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Glycemic Impact on Knee Osteoarthritis Symptoms on Physical, Radiographic, and Inflammatory Markers among Individuals Aged 50 and Over with Diabetes

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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.

|November 3, 2023

Summary

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.

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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.