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Pediatr Emerg Care. 1996 Oct;12(5):347-51.

Laboratory presentation in diabetic ketoacidosis and duration of therapy.

Author information

1
Emergency Department, Miami Children's Hospital, FL 33155-3098, USA.

Abstract

OBJECTIVE:

To determine if initial emergency department (ED) laboratory parameters in children with diabetic ketoacidosis (DKA) can predict the minimum duration of continuous insulin therapy and aid in ED triage.

DESIGN:

Retrospective chart review, over a four-year period.

SETTING:

Tertiary care pediatric center ED.

PATIENTS:

All patients in DKA, managed with a standard hospital protocol were included. Standard therapy consisted of an intravenous infusion over an hour of normal saline or Ringer's lactate, followed by 0.45% saline (potassium acetate/ phosphate added) at 1.5 times maintenance and insulin infusion (0.1 units/kg/h). New-onset diabetic patients were excluded.

MAIN RESULTS:

One hundred thirty-two visits (45 patients, 55.5% female) were reviewed. Three of 60 (5%) patient-visits with moderate to severe DKA (serum pH < 7.20 and serum bicarbonate concentration < 10 mmol/L) had their acidosis corrected (serum pH > or = 7.30 or serum bicarbonate concentration > or = 15 mmol/L) within four hours compared to 33 of 72 (46%) patient-visits with mild DKA (serum pH > or = 7.20 or serum bicarbonate concentration > or = 10 mmol/L) (P < 0.0001). The acidosis was corrected within six hours in 69 and 11% of the mild and moderate-severe DKA group, respectively (P < 0.0001).

CONCLUSIONS:

Initial laboratory presentation can help predict the minimum necessary duration of therapy in pediatric patient with DKA, aid early triage decision in the ED, and select a subgroup of patients who may be considered for outpatient management.

PMID:
8897542
[Indexed for MEDLINE]

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