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
- 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)