Fluid Management in the Pediatric DKA Patient
This month JC is most happy to welcome the return of our Peds EM colleagues. We will be looking at management of DKA and will include the International Society for Pediatric and Adolescent Diabetes (ISPAD) 2018 update to their DKA and HHS 2014 guidelines. We will also review a recent NEJM article by the PECARN group, that is getting lots of attention as potentially ‘practice changing’ data regarding fluid management in DKA. My attempt to broaden the topic led me to an article by CHKD’s own Drs. Poirer and Satin-Smith, that was the first prospective study on using a "two-bag" approach to DKA fluid management. Since then, there is a 2017 article by Munir et al. on the same topic in the adult population that introduces this novel approach that will be reviewed as well. Although DKA can be considered a ‘bread and butter’ EM complaint, the risks of a bad outcome particularly in patients at risk for cerebral edema can be high and the data on how to identify those at highest risk is lacking.
Wolfsdorf JI et al, Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State: A Consensus Statement from the International Society for Pediatric and Adolescent Diabetes. Pediatr Diabetes. 2018 Jun 13. Appraisal
Munir et al, Comparison of a 'two-bag system' versus conventional treatment protocol ('one-bag system') in the management of diabetic ketoacidosis. BMJ Open Diabetes Res Care. 2017 Aug 11;5(1) Appraisal
Kuppermann N. et al, Clinical Trial of Fluid Infusion Rates for Pediatric Diabetic Ketoacidosis. PECARN DKA FLUID Study Group. N Engl J Med. 2018 Jun 14;378(24) Appraisal