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Laboratory presentation in diabetic ketoacidosis and duration of therapy
M Y Linares1, J E Schunk, R Lindsay
1Emergency Department, Miami Children's Hospital, FL 33155-3098, USA.
Insights
Initial laboratory results in children with diabetic ketoacidosis (DKA) can predict treatment duration. This helps in emergency department triage and identifying candidates for outpatient management.
Area of Science:
- Pediatric Endocrinology
- Emergency Medicine
- Metabolic Disorders
Background:
- Diabetic ketoacidosis (DKA) is a serious complication of diabetes in children.
- Predicting treatment duration and optimizing emergency department (ED) triage for DKA are crucial for efficient patient management.
Purpose of the Study:
- To evaluate if initial emergency department laboratory parameters in pediatric patients with DKA can predict the minimum duration of continuous insulin therapy.
- To assess the utility of these parameters in aiding ED triage decisions.
Main Methods:
- Retrospective chart review of 132 patient visits over a four-year period at a tertiary care pediatric center.
- Analysis of standard hospital DKA management protocol including intravenous fluids and insulin infusion (0.1 units/kg/h).
- Exclusion of new-onset diabetic patients.
Main Results:
- Patients with mild DKA (serum pH ≥ 7.20 or bicarbonate ≥ 10 mmol/L) had significantly faster acidosis correction (46% within 4 hours) compared to moderate-severe DKA (5%) (P < 0.0001).
- Acidosis correction within six hours was achieved in 69% of mild DKA cases versus 11% of moderate-severe DKA cases (P < 0.0001).
Conclusions:
- Initial laboratory findings in pediatric DKA are predictive of the minimum required insulin therapy duration.
- These parameters can assist in early triage decisions within the ED.
- A subgroup of DKA patients may be suitable for outpatient management based on initial presentation.
Objective:
To determine if initial emergency department (ED) laboratory parameters in children with diabetic ketoacidosis (DKA) can predict the minimum duration of continuous insulin therapy and aid in ED triage.
Design:
Retrospective chart review, over a four-year period.
Setting:
Tertiary care pediatric center ED.
Patients:
All patients in DKA, managed with a standard hospital protocol were included. Standard therapy consisted of an intravenous infusion over an hour of normal saline or Ringer's lactate, followed by 0.45% saline (potassium acetate/ phosphate added) at 1.5 times maintenance and insulin infusion (0.1 units/kg/h). New-onset diabetic patients were excluded.
Main Results:
One hundred thirty-two visits (45 patients, 55.5% female) were reviewed. Three of 60 (5%) patient-visits with moderate to severe DKA (serum pH < 7.20 and serum bicarbonate concentration < 10 mmol/L) had their acidosis corrected (serum pH > or = 7.30 or serum bicarbonate concentration > or = 15 mmol/L) within four hours compared to 33 of 72 (46%) patient-visits with mild DKA (serum pH > or = 7.20 or serum bicarbonate concentration > or = 10 mmol/L) (P < 0.0001). The acidosis was corrected within six hours in 69 and 11% of the mild and moderate-severe DKA group, respectively (P < 0.0001).
Conclusions:
Initial laboratory presentation can help predict the minimum necessary duration of therapy in pediatric patient with DKA, aid early triage decision in the ED, and select a subgroup of patients who may be considered for outpatient management.