TY - JOUR
T1 - Clinical and Laboratory Predictors of Dehydration Severity in Children With Diabetic Ketoacidosis
AU - Pediatric Emergency Care Applied Research Network (PECARN) FLUID Study Group
AU - Trainor, Jennifer L.
AU - Glaser, Nicole S.
AU - Tzimenatos, Leah
AU - Stoner, Michael J.
AU - Brown, Kathleen M.
AU - McManemy, Julie K.
AU - Schunk, Jeffrey E.
AU - Quayle, Kimberly S.
AU - Nigrovic, Lise E.
AU - Rewers, Arleta
AU - Myers, Sage R.
AU - Bennett, Jonathan E.
AU - Kwok, Maria Y.
AU - Olsen, Cody S.
AU - Casper, T. Charles
AU - Ghetti, Simona
AU - Kuppermann, Nathan
AU - Perry, Clinton S.
AU - Marcin, James P.
AU - Murray, Mary
AU - Henricksen, Jared
AU - Poss, Brad
AU - Dean, J. Michael
AU - Bonsu, Bema
AU - Maa, Tensing
AU - Indyk, Justin
AU - Rewers, Marian
AU - Mourani, Peter
AU - Kushner, Jake A.
AU - Loftis, Laura L.
AU - Goyal, Monika
AU - Mistry, Rakesh
AU - Srinivasan, Vijay
AU - Palladino, Andrew
AU - Hawkes, Colin
AU - Wolfsdorf, Joseph I.
AU - Agus, Michael S.
AU - Snelling, Linda
AU - Boney, Charlotte
AU - Cogen, Fran R.
AU - Basu, Sonali
AU - White, Neil H.
AU - Kolovos, Nikoleta S.
AU - Zimmerman, Donald
AU - Goodman, Denise
AU - DePiero, Andrew D.
AU - Doyle, Daniel A.
AU - Frizzola, Meg A.
AU - Baird, Scott
AU - Schnadower, David
N1 - Publisher Copyright:
© 2023 American College of Emergency Physicians
PY - 2023/8
Y1 - 2023/8
N2 - Study objective: Our primary objective was to characterize the degree of dehydration in children with diabetic ketoacidosis (DKA) and identify physical examination and biochemical factors associated with dehydration severity. Secondary objectives included describing relationships between dehydration severity and other clinical outcomes. Methods: In this cohort study, we analyzed data from 753 children with 811 episodes of DKA in the Pediatric Emergency Care Applied Research Network Fluid Therapies Under Investigation Study, a randomized clinical trial of fluid resuscitation protocols for children with DKA. We used multivariable regression analyses to identify physical examination and biochemical factors associated with dehydration severity, and we described associations between dehydration severity and DKA outcomes. Results: Mean dehydration was 5.7% (SD 3.6%). Mild (0 to <5%), moderate (5 to <10%), and severe (≥10%) dehydration were observed in 47% (N=379), 42% (N=343), and 11% (N=89) of episodes, respectively. In multivariable analyses, more severe dehydration was associated with new onset of diabetes, higher blood urea nitrogen, lower pH, higher anion gap, and diastolic hypertension. However, there was substantial overlap in these variables between dehydration groups. The mean length of hospital stay was longer for patients with moderate and severe dehydration, both in new onset and established diabetes. Conclusion: Most children with DKA have mild-to-moderate dehydration. Although biochemical measures were more closely associated with the severity of dehydration than clinical assessments, neither were sufficiently predictive to inform rehydration practice.
AB - Study objective: Our primary objective was to characterize the degree of dehydration in children with diabetic ketoacidosis (DKA) and identify physical examination and biochemical factors associated with dehydration severity. Secondary objectives included describing relationships between dehydration severity and other clinical outcomes. Methods: In this cohort study, we analyzed data from 753 children with 811 episodes of DKA in the Pediatric Emergency Care Applied Research Network Fluid Therapies Under Investigation Study, a randomized clinical trial of fluid resuscitation protocols for children with DKA. We used multivariable regression analyses to identify physical examination and biochemical factors associated with dehydration severity, and we described associations between dehydration severity and DKA outcomes. Results: Mean dehydration was 5.7% (SD 3.6%). Mild (0 to <5%), moderate (5 to <10%), and severe (≥10%) dehydration were observed in 47% (N=379), 42% (N=343), and 11% (N=89) of episodes, respectively. In multivariable analyses, more severe dehydration was associated with new onset of diabetes, higher blood urea nitrogen, lower pH, higher anion gap, and diastolic hypertension. However, there was substantial overlap in these variables between dehydration groups. The mean length of hospital stay was longer for patients with moderate and severe dehydration, both in new onset and established diabetes. Conclusion: Most children with DKA have mild-to-moderate dehydration. Although biochemical measures were more closely associated with the severity of dehydration than clinical assessments, neither were sufficiently predictive to inform rehydration practice.
UR - http://www.scopus.com/inward/record.url?scp=85151621562&partnerID=8YFLogxK
U2 - 10.1016/j.annemergmed.2023.01.001
DO - 10.1016/j.annemergmed.2023.01.001
M3 - Article
C2 - 37024382
AN - SCOPUS:85151621562
SN - 0196-0644
VL - 82
SP - 167
EP - 178
JO - Annals of emergency medicine
JF - Annals of emergency medicine
IS - 2
ER -