PMID- 26823137
OWN - NLM
STAT- MEDLINE
DCOM- 20170103
LR  - 20170104
IS  - 0736-4679 (Print)
IS  - 0736-4679 (Linking)
VI  - 50
IP  - 4
DP  - 2016 Apr
TI  - Effect of Volume of Fluid Resuscitation on Metabolic Normalization in Children
      Presenting in Diabetic Ketoacidosis: A Randomized Controlled Trial.
PG  - 551-9
LID - 10.1016/j.jemermed.2015.12.003 [doi]
LID - S0736-4679(15)01384-0 [pii]
AB  - BACKGROUND: The optimal rate of fluid administration in pediatric diabetic
      ketoacidosis (DKA) is unknown. OBJECTIVE: Our aim was to determine whether the
      volume of fluid administration in children with DKA influences the rate of
      metabolic normalization. METHODS: We performed a randomized controlled trial
      conducted in a tertiary pediatric emergency department from December 2007 until
      June 2010. The primary outcome was time to metabolic normalization; secondary
      outcomes were time to bicarbonate normalization, pH normalization, overall length
      of hospital treatment, and adverse outcomes. Children between 0 and 18 years of
      age were eligible if they had type 1 diabetes mellitus and DKA. Patients were
      randomized to receive intravenous (IV) fluid at low volume (10 mL/kg bolus + 1.25
      x maintenance rate) or high volume (20 mL/kg bolus + 1.5 x maintenance rate) (n =
      25 in each). RESULTS: After adjusting for initial differences in bicarbonate
      levels, time to metabolic normalization was significantly faster in the
      higher-volume infusion group compared to the low-volume infusion group (hazard
      ratio [HR] = 2.0; 95% confidence interval [CI] 1.0-3.9; p = 0.04). Higher-volume 
      IV fluid infusion appeared to hasten, to a greater extent, normalization of pH
      (HR = 2.5; 95% CI 1.2-5.0; p = 0.01) than normalization of serum bicarbonate (HR 
      = 1.2; 95% CI 0.6-2.3; p = 0.6). The length of hospital treatment HR (0.8; 95% CI
      0.4-1.5; p = 0.5) and time to discharge HR (0.8; 95% CI 0.4-1.5; p = 0.5) did not
      differ between treatment groups. CONCLUSIONS: Higher-volume fluid infusion in the
      treatment of pediatric DKA patients significantly shortened metabolic
      normalization time, but did not change overall length of hospital treatment.
      ClinicalTrials.gov ID NCT01701557.
CI  - Copyright (c) 2016 Elsevier Inc. All rights reserved.
FAU - Bakes, Katherine
AU  - Bakes K
AD  - Department of Emergency Medicine, Denver Health Medical Center, University of
      Colorado, School of Medicine, Denver, Colorado.
FAU - Haukoos, Jason S
AU  - Haukoos JS
AD  - Department of Emergency Medicine, Denver Health Medical Center, University of
      Colorado, School of Medicine, Denver, Colorado; Department of Epidemiology,
      Colorado School of Public Health, University of Colorado, Aurora, Colorado.
FAU - Deakyne, Sara J
AU  - Deakyne SJ
AD  - Department of Research Informatics, Children's Hospital Colorado, Research
      Institute, Aurora, Colorado.
FAU - Hopkins, Emily
AU  - Hopkins E
AD  - Department of Emergency Medicine, Denver Health Medical Center, University of
      Colorado, School of Medicine, Denver, Colorado.
FAU - Easter, Josh
AU  - Easter J
AD  - Department of Emergency Medicine, Denver Health Medical Center, University of
      Colorado, School of Medicine, Denver, Colorado.
FAU - McFann, Kim
AU  - McFann K
AD  - Colorado School of Public Health, University of Colorado, Aurora, Colorado.
FAU - Brent, Alison
AU  - Brent A
AD  - Section Emergency Medicine, Department of Pediatrics, University of Colorado,
      School of Medicine, Aurora, Colorado.
FAU - Rewers, Arleta
AU  - Rewers A
AD  - Section Emergency Medicine, Department of Pediatrics, University of Colorado,
      School of Medicine, Aurora, Colorado.
LA  - eng
SI  - ClinicalTrials.gov/NCT01701557
PT  - Journal Article
PT  - Randomized Controlled Trial
DEP - 20160125
PL  - United States
TA  - J Emerg Med
JT  - The Journal of emergency medicine
JID - 8412174
RN  - 0 (Bicarbonates)
RN  - 0 (Biomarkers)
SB  - IM
MH  - Adolescent
MH  - Bicarbonates/therapeutic use
MH  - Biomarkers/blood
MH  - Child
MH  - Diabetic Ketoacidosis/*therapy
MH  - Emergency Service, Hospital
MH  - Female
MH  - Fluid Therapy/*methods
MH  - Humans
MH  - Length of Stay/statistics & numerical data
MH  - Male
MH  - Treatment Outcome
OTO - NOTNLM
OT  - DKA
OT  - acidosis
OT  - bicarbonate
OT  - fluid resuscitation
OT  - ketoacidosis
OT  - ketones
OT  - pediatric diabetes
EDAT- 2016/01/30 06:00
MHDA- 2017/01/04 06:00
CRDT- 2016/01/30 06:00
PHST- 2015/01/28 00:00 [received]
PHST- 2015/11/19 00:00 [revised]
PHST- 2015/12/13 00:00 [accepted]
PHST- 2016/01/30 06:00 [entrez]
PHST- 2016/01/30 06:00 [pubmed]
PHST- 2017/01/04 06:00 [medline]
AID - S0736-4679(15)01384-0 [pii]
AID - 10.1016/j.jemermed.2015.12.003 [doi]
PST - ppublish
SO  - J Emerg Med. 2016 Apr;50(4):551-9. doi: 10.1016/j.jemermed.2015.12.003. Epub 2016
      Jan 25.