Fluid management in pediatric patients with DKA and rates of suspected clinical cerebral edema.
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Clinical Guidelines
Authored By
Hsia DS, Tarai SG, Alimi A, Coss-Bu JA, Haymond MW
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Interests
Pediatric Medicine
Neurology
Emergency Medicine
Surgery
Speciality
Neurology
Pediatric Medicine
Surgery
Emergency Medicine
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volume
16
ISSN
1399-5448
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{"article_title":"Fluid management in pediatric patients with DKA and rates of suspected clinical cerebral edema.","author":"Hsia DS, Tarai SG, Alimi A, Coss-Bu JA, Haymond MW","journal_title":"Pediatric diabetes","issn":"1399-5448","isbn":"","publication_date":"2015 Aug","volume":"16","issue":"5","first_page":"338","page_count":"","accession_number":"25800410","doi":"10.1111\/pedi.12268","publisher":"Munksgaard","doctype":"Comparative Study","subjects":"Brain Edema epidemiology; Diabetic Ketoacidosis epidemiology; Diabetic Ketoacidosis therapy; Fluid Therapy methods; Adolescent; Brain Edema etiology; Child; Diabetic Ketoacidosis complications; Female; Fluid Therapy statistics & numerical data; Humans; Incidence; Isotonic Solutions therapeutic use; Male; Retrospective Studies; Ringer's Lactate; Sodium Chloride therapeutic use; Treatment Outcome","interest_area":["Pediatric Medicine"," Neurology"," Emergency Medicine"," Surgery"],"abstract":"Objective: To compare outcomes of diabetic ketoacidosis (DKA) 6 yrs before and 6 yrs after changing rehydration fluids from \ufffd normal saline to Lactated Ringer's and decreasing the total intended fluid volume administered in the first 24 hrs from 3500 mL\/m(2) \/d to ? 2500 mL\/m(2) \/d at Texas Children's Hospital (TCH) in response to recommendations by the ESPE, LWPES, and ISPAD in 2004. Subjects\/methods: A retrospective cohort study was conducted in which 1868 admissions for DKA were identified and reviewed. The cohort was divided into two groups: Group A, 1998-2004, and Group B, 2004-2010. Subjects with suspected clinical cerebral edema and adverse outcomes were identified. Results: Although not statistically significant, there was an equal number (n = 3) of adverse outcomes (death or neurological damage) in each group despite more than double the admissions in Group B (1264) compared with those in Group A (604). Overall, the incidence of suspected clinical cerebral edema was more than double for those admissions in which fluid resuscitation was initiated at an outside hospital (OSH) vs. at TCH (13.6 vs. 5.3%, p < 0.001). Conclusions: Decreasing the intended fluid rate during the initial 24 hrs to 2500 mL\/m(2) \/d and increasing the IV fluid sodium content did not significantly decrease the incidence of adverse outcomes in children with DKA. However, children transferred from an OSH had a higher incidence of suspected clinical cerebral edema. Thus, we need to more readily share our management protocols with the emergency rooms of local referring hospitals to potentially decrease the incidence of suspected clinical cerebral edema and adverse outcomes in children transferred with DKA. \ufffd 2015 John Wiley & Sons A\/S. Published by John Wiley & Sons Ltd.","url":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&db=mdl&AN=25800410&authtype=shib&custid=ns346513","isPdfLink":true,"isSAML":false,"additionalInfo":{"Authored_By":"Hsia DS, Tarai SG, Alimi A, Coss-Bu JA, Haymond MW","Journal_Info":"Publisher: Munksgaard Country of Publication: Denmark NLM ID: 100939345 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1399-5448 (Electronic) Linking ISSN: 1399543X NLM ISO Abbreviation: Pediatr Diabetes Subsets: MEDLINE","Publication_Type":"Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, Non-P.H.S.","Published_Date":"2015-08-01","Source":"Pediatric diabetes [Pediatr Diabetes] 2015 Aug; Vol. 16 (5), pp. 338-44. Date of Electronic Publication: 2015 Mar 19.","Languages":"English","Electronic_ISSN":"1399-5448","MeSH_Terms":"Brain Edema\/*epidemiology , Diabetic Ketoacidosis\/*epidemiology , Diabetic Ketoacidosis\/*therapy , Fluid Therapy\/*methods, Adolescent ; Brain Edema\/etiology ; Child ; Diabetic Ketoacidosis\/complications ; Female ; Fluid Therapy\/statistics & numerical data ; Humans ; Incidence ; Isotonic Solutions\/therapeutic use ; Male ; Retrospective Studies ; Ringer's Lactate ; Sodium Chloride\/therapeutic use ; Treatment Outcome","Subjects":"Adolescent, Brain Edema etiology, Child, Diabetic Ketoacidosis complications, Female, Fluid Therapy statistics & numerical data, Humans, Incidence, Isotonic Solutions therapeutic use, Male, Retrospective Studies, Ringer's Lactate, Sodium Chloride therapeutic use, Treatment Outcome, Brain Edema epidemiology, Diabetic Ketoacidosis epidemiology, Diabetic Ketoacidosis therapy, Fluid Therapy methods","Title_Abbreviations":"Pediatric diabetes","Volume":"16"},"header":{"DbId":"mdl","DbLabel":"MEDLINE Ultimate","An":"25800410","RelevancyScore":"786","PubType":"Academic Journal","PubTypeId":"academicJournal","PreciseRelevancyScore":"786.407836914063"},"plink":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&site=eds-live&db=mdl&AN=25800410&authtype=shib&custid=ns346513&group=main&profile=eds","upload_link":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&site=eds-live&db=mdl&AN=25800410&authtype=shib&custid=ns346513&group=main&profile=eds"}
