Management of Pediatric Diabetic Ketoacidosis – a Comparison between a Conventional Protocol and a Novel Osmolality Control Protocol
Yli-Juuti, Roosa (2021-03-17)
Management of Pediatric Diabetic Ketoacidosis – a Comparison between a Conventional Protocol and a Novel Osmolality Control Protocol
(17.03.2021)
Julkaisu on tekijänoikeussäännösten alainen. Teosta voi lukea ja tulostaa henkilökohtaista käyttöä varten. Käyttö kaupallisiin tarkoituksiin on kielletty.
avoin
Julkaisun pysyvä osoite on:
https://urn.fi/URN:NBN:fi-fe202104099829
https://urn.fi/URN:NBN:fi-fe202104099829
Tiivistelmä
Background: Diabetic ketoacidosis (DKA) is conventionally treated using a single line for administration of ready-made dextrose and saline solutions for rehydration. For some patients this results in poor control of plasma glucose, sodium, and effective osmolality.
Objective: Management of pediatric DKA requires close monitoring and frequent titration of fluids, electrolytes, and dextrose. Because there is no consensus on the safest DKA protocol, treatment is challenging. We developed a novel treatment protocol for DKA that allows precise titration of dextrose and of the plasma sodium concentration and fluid volume by adjusting the infusion rates of three separate lines.
Methods: We conducted a retrospective single-center study of 60 consecutive pediatric DKA patients (age 7 months to 16 years) treated in a tertiary hospital in Turku, Finland. The first 26 patients were treated with the conventional and the following 34 patients with the novel protocol. We collected and analyzed clinical and laboratory data, timing of medical interventions and clinical outcomes from the electronic patient record system.
Results: Plasma effective osmolality remained more stable when the patient was treated according to the novel protocol than the conventional protocol (p < 0.001) and plasma sodium levels were higher (p = 0.018). Recovery from acidosis was also faster. Two patients on the conventional protocol needed intracranial pressure monitoring and ventilator support, none on the novel protocol. There were no deaths in either protocol.
Conclusions: Our novel protocol allows more precise control of the effective plasma osmolality and appears to be as safe as the conventional protocol.
Objective: Management of pediatric DKA requires close monitoring and frequent titration of fluids, electrolytes, and dextrose. Because there is no consensus on the safest DKA protocol, treatment is challenging. We developed a novel treatment protocol for DKA that allows precise titration of dextrose and of the plasma sodium concentration and fluid volume by adjusting the infusion rates of three separate lines.
Methods: We conducted a retrospective single-center study of 60 consecutive pediatric DKA patients (age 7 months to 16 years) treated in a tertiary hospital in Turku, Finland. The first 26 patients were treated with the conventional and the following 34 patients with the novel protocol. We collected and analyzed clinical and laboratory data, timing of medical interventions and clinical outcomes from the electronic patient record system.
Results: Plasma effective osmolality remained more stable when the patient was treated according to the novel protocol than the conventional protocol (p < 0.001) and plasma sodium levels were higher (p = 0.018). Recovery from acidosis was also faster. Two patients on the conventional protocol needed intracranial pressure monitoring and ventilator support, none on the novel protocol. There were no deaths in either protocol.
Conclusions: Our novel protocol allows more precise control of the effective plasma osmolality and appears to be as safe as the conventional protocol.