Initial fluid management of diabetic ketoacidosis in children

The purpose of this study was to review the emergency department management of children presenting in diabetic ketoacidosis (DKA) to determine if curr ent recommendations for fluid therapy are practiced. A 5-year retrospective chart review was conducted of all pediatric patients admitted with DKA to the University of Alberta Hospital. Presenting clinical and laboratory data , the initial fluid therapy, and insulin dose were analyzed. The therapy wa s also compared between sites of initial presentation (primary, secondary, or tertiary hospital). A total of 49 cases of DKA in 37 patients were revie wed. There were no significant clinical or biochemical differences between patients presenting at the three levels of hospital. Forty one cases (84%) were given a saline bolus and the mean fluid volume given by 1 hour was 18. 3 mL/kg. In the first hour 82% of patients presenting at a primary or secon dary centre and 67% of those at the tertiary centre received more than 10 m L/kg. This excessive fluid therapy was also evident after 4 hours. Fluid ma nagement of children in DKA is excessive and not in keeping with current re commendations. Education of emergency physicians is needed to reduce fluid therapy and the risk of neurologic complications. (Am J Emerg Med 2000;18:6 58-660. Copyright (C) 2000 by W.B. Saunders Company).