In this post I link to and excerpt from Pediatric DKA Update on Fluid Management and Cerebral Edema from Trekk (Translating Emergency Knowledge For Kids) in EMC Quick Hits 21, August, 2020.
Here are the show notes:
Pediatric DKA Update on Fluid Management and Cerebral Edema
- A practice changing PECARN study compared two fluid protocols in 1,389 cases of DKA
- Fast protocol: 10 mL/kg bolus + 10 mL/kg bolus (both with NS) followed by replacement of a 10% fluid deficit + maintenance over 36 hours with either NS or 0.45 NS
- Slow protocol: 10 mL/kg bolus (with NS) followed by replacement of a 5% fluid deficit + maintenance over 48 hours with either NS or 0.45 NS
- No difference between the fluid protocols in worsening mental status, cerebral injury, or post-DKA cognitive function
Bottom line: we don’t have to be so judicious with fluids in pediatric DKA; it’s almost always safe to start your resuscitation with 10mL/kg NS bolus regardless of fluid status and repeat if still hypoperfused
Reference List
- Kuppermann N, Ghetti S, Schunk JE, et al. Clinical Trial of Fluid Infusion Rates for Pediatric Diabetic Ketoacidosis. N Engl J Med. 2018;378(24):2275-2287.
- Wolfsdorf JI, Glaser N, Agus M, et al. ISPAD Clinical Practice Consensus Guidelines 2018: Diabetic ketoacidosis and the hyperglycemic hyperosmolar state. Pediatr Diabetes. 2018;19 Suppl 27:155-177.
- TREKK DKA Bottom Line Recommendations: https://trekk.ca/system/assets/assets/attachments/402/original/2019-06-18_DKA_BLR_v_3.1.pdf?1561062009 (accessed Jan 14, 2020)
- TREKK DKA Development Team: https://trekk.ca/system/assets/assets/attachments/350/original/2019-01-11_DKA_Refs_and_Devt_Team.pdf?1547230365 (accessed Jan 14, 2020)
