@article{3fd815b3f06849648d6837bcfcc6a163,
title = "Effects of Fluid Rehydration Strategy on Correction of Acidosis and Electrolyte Abnormalities in Children With Diabetic Ketoacidosis",
abstract = "OBJECTIVE Fluid replacement to correct dehydration, acidosis, and electrolyte abnormalities is the cornerstone of treatment for diabetic ketoacidosis (DKA), but little is known about optimal fluid infusion rates and electrolyte content. The objective of this study was to evaluate whether different fluid protocols affect the rate of normalization of biochemical derangements during DKA treatment. RESEARCH DESIGN AND METHODS The current analysis involved moderate or severe DKA episodes (n = 714) in children age <18 years enrolled in the Fluid Therapies Under Investigation in DKA (FLUID) Trial. Children were assigned to one of four treatment groups using a 2 2 factorial design (0.90% or 0.45% saline and fast or slow rate of administration). RESULTS The rate of change of pH did not differ by treatment arm, but PCO2 increased more rapidly in the fast versus slow fluid infusion arms during the initial 4 h of treatment. The anion gap also decreased more rapidly in the fast versus slow infusion arms during the initial 4 and 8 h. Glucose-corrected sodium levels remained stable in patients assigned to 0.90% saline but decreased in those assigned to 0.45% saline at 4 and 8 h. Potassium levels decreased, while chloride levels increased more rapidly with 0.90% versus 0.45% saline. Hyperchloremic acidosis occurred more frequently in patients in the fast arms (46.1%) versus the slow arms (35.2%). CONCLUSIONS In children treated for DKA, faster fluid administration rates led to a more rapid normalization of anion gap and PCO2 than slower fluid infusion rates but were associated with an increased frequency of hyperchloremic acidosis.",
author = "{the Pediatric Emergency Care Applied Research Network (PECARN) FLUID Study Group} and Arleta Rewers and Nathan Kuppermann and Stoner, {Michael J.} and Aris Garro and Bennett, {Jonathan E.} and Quayle, {Kimberly S.} and Schunk, {Jeffrey E.} and Myers, {Sage R.} and McManemy, {Julie K.} and Nigrovic, {Lise E.} and Trainor, {Jennifer L.} and Leah Tzimenatos and Kwok, {Maria Y.} and Brown, {Kathleen M.} and Olsen, {Cody S.} and Casper, {T. Charles} and Simona Ghetti and Glaser, {Nicole S.}",
note = "Funding Information: National Institute of Child and Human Development, Bethesda, MD], Thomas Cook [Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI], and Beth Slomine [Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD]), and the members of the study outcome adjudication committee (Kathleen Meert [Department of Pediatrics, Children{\textquoteright}s Hospital of Michigan, Detroit, MI], Jerry Zimmerman [Center for Clinical and Translational Research, Seattle Children{\textquoteright}s Hospital, Seattle, WA], and Robert Hickey [Division of Pediatric Emergency Medicine, Children{\textquoteright}s Hospital of Pittsburgh, Pittsburgh, PA]). Funding. This study was supported by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (U01-HD-062417). This project was also supported in part by the Health Resources and Services Administration, Maternal and Child Health Bureau, and Emergency Medical Services for Children Network Development Demonstration Program under cooperative agreement numbers U03-MC-00008, U03-MC-00001, U03-MC-00003, U03-MC-00006, U03-MC-00007, U03-MC-22684, and U03-MC-22685. Funding Information: This study was supported by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (U01-HD-062417). This project was also supported in part by the Health Resources and Services Administration, Maternal and Child Health Bureau, and Emergency Medical Services for Children Network Development Demonstration Program under cooperative agreement numbers U03-MC-00008, U03-MC-00001, U03-MC-00003, U03-MC-00006, U03-MC-00007, U03-MC-22684, and U03-MC-22685. This information, content, and conclusions of this article are those of the authors and should not be construed as the official position or policy of, and no endorsements should be inferred by, the Health Resources and Services Administration, Department of Health and Human Services, or the U.S. government. Publisher Copyright: {\textcopyright} 2021 by the American Diabetes Association.",
year = "2021",
month = sep,
doi = "10.2337/DC20-3113",
language = "English",
volume = "44",
pages = "2061--2068",
journal = "Diabetes care",
issn = "0149-5992",
number = "9",
}