LABORATORY PRESENTATION IN DIABETIC-KETOACIDOSIS AND DURATION OF THERAPY

Objective: To determine if initial emergency department (ED) laborator y parameters in children with diabetic ketoacidosis (DKA) can predict the minimum duration of continuous insulin therapy and aid in ED triag e. Design: Retrospective chart review, over a four-year period. Settin g: Tertiary care pediatric center ED. Patients: All patients in DKA, m anaged with a standard hospital protocol were included. Standard thera py consisted of an intravenous infusion over an hour of normal saline or Ringer's lactate, followed by 0.45% saline (potassium acetate/phosp hate added) at 1.5 times maintenance and insulin infusion (0.1 units/k g/h). New-onset diabetic patients were excluded. Main results: One hun dred thirty-two visits (45 patients, 55.5% female) were reviewed. Thre e 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 greater than or equal to 7.30 or serum bicarbonat e concentration greater than or equal to 15 mmol/L) within four hours compared to 33 of 72 (46%) patient-visits with mild DKA (serum pH grea ter than or equal to 7.20 or serum bicarbonate concentration greater t han or equal to 10 mmol/L) (P < 0.0001). The acidosis was corrected wi thin six hours in 69 and 11% of the mild and moderate-severe DKA group , respectively (P < 0.0001). Conclusions: Initial laboratory presentat ion can help predict the minimum necessary duration of therapy in pedi atric patient with DKA, aid early triage decision in the ED, and selec t a subgroup of patients who may be considered for outpatient manageme nt.