Physiologic Management of Diabetic Ketoacidemia: A 5-Year Prospective Pediatric Experience in 231 Episodes

doi:10.1001/archpedi.1994.02170100044009

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Vol. 148 No. 10, October 1994

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Physiologic Management of Diabetic Ketoacidemia

A 5-Year Prospective Pediatric Experience in 231 Episodes

Glenn D. Harris, MD; Irma Fiordalisi, MD

Arch Pediatr Adolesc Med. 1994;148(10):1046-1052.

Abstract

Objective
To determine whether gradual rehydration in moderate and severediabetic ketoacidemia (DKA) can safely prevent untoward declinesin calculated effective osmolality (E_osm) early in treatmentand, hence, help prevent major central nervous system complications.

Design
Prospective study.

Setting
Three tertiary care hospitals.

Patients
Two hundred thirty-one consecutive episodes of DKA in 149 patientsaged 10 months to 20 years admitted during a 5-year period.

Interventions
Insulin therapy in addition to rehydration using an estimatedvolume of deficit with planned administration over 48 hours;initial administration of rehydration solutions with an osmolalityapproximating that of the patient; and intensive patient monitoring.

Measurements
Mean lowest calculated E_osm (Eosm_l) during the first 24 hoursof treatment; trend of the concentration of sodium in serumin the first 12 hours of treatment; comparison of pretreatmentserum concentrations of glucose, urea nitrogen, and correctedsodium between mildly and very severely dehydrated patients;and patient outcome.

Results
A mean (±SD) Eosm_l of 285.8±10.5 mOsm/kg Naterand an increase in the concentration of sodium in serum in 90%of episodes were documented. There were statistically significantdifferences in serum concentrations of glucose, urea nitrogen,and corrected sodium in mildly vs very severely dehydrated patients.There were no deaths or near-death episodes.

Conclusions
Management of moderate and severe DKA with a 48-hour plannedrehydration is safe and prevents untoward declines in E_osm.Coupled with intensive monitoring, gradual rehydration can protectagainst life-threatening increases in intracranial pressureand brain herniation.

(Arch Pediatr Adolesc Med. 1994;148:1046-1052)

Author Affiliations

From the Department of Pediatrics, Section of Critical Care, East Carolina University School of Medicine, Greenville, NC.

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