@article{d6fb1a8f262347828aa3fdaf16cbbd1f,
title = "Serum sodium concentration and mental status in children with diabetic ketoacidosis",
abstract = "OBJECTIVES: Diabetic ketoacidosis (DKA) is typically characterized by low or low-normal serum sodium concentrations, which rise as hyperglycemia resolves. In retrospective studies, researchers found associations between declines in sodium concentrations during DKA and cerebral injury. We prospectively investigated determinants of sodium concentration changes and associations with mental status alterations during DKA. METHODS: Using data from the Pediatric Emergency Care Applied Research Network Fluid Therapies Under Investigation in Diabetic Ketoacidosis Trial, we compared children who had declines in glucose-corrected sodium concentrations with those who had rising or stable concentrations. Children were randomly assigned to 1 of 4 intravenous fluid protocols that differed in infusion rate and sodium content. Data from the first 4, 8, and 12 hours of treatment were analyzed for 1251, 1086, and 877 episodes, respectively. RESULTS: In multivariable analyses, declines in glucose-corrected sodium concentrations were associated with higher sodium and chloride concentrations at presentation and with previously diagnosed diabetes. Treatment with 0.45% (vs 0.9%) sodium chloride fluids was also associated with declines in sodium concentration; however, higher rates of fluid infusion were associated with declines in sodium concentration only at 12 hours. Frequencies of abnormal Glasgow Coma Scale scores and clinical diagnoses of cerebral injury were similar in patients with and without declines in glucose-corrected sodium concentrations. CONCLUSIONS: Changes in glucose-corrected sodium concentrations during DKA treatment are influenced by the balance of free-water loss versus sodium loss at presentation and the sodium content of intravenous fluids. Declines in glucose-corrected sodium concentrations are not associated with mental status changes during treatment.",
author = "{Pediatric Emergency Care Applied Research Network (PECARN) DKA FLUID Study Group} and Glaser, {Nicole S.} and Stoner, {Michael J.} and Aris Garro and Scott Baird and Myers, {Sage R.} and Arleta Rewers and Brown, {Kathleen M.} and Trainor, {Jennifer L.} and Quayle, {Kimberly S.} and McManemy, {Julie K.} and DePiero, {Andrew D.} and Nigrovic, {Lise E.} and Leah Tzimenatos and Schunk, {Jeff E.} and Olsen, {Cody S.} and Casper, {T. Charles} and Simona Ghetti and Nathan Kuppermann and Perry, {Clinton S.} and Marcin, {James P.} and Mary Murray and Jared Henricksen and Brad Poss and Dean, {J. Michael} and Bema Bonsu and Tensing Maa and Justin Indyk and Marian Rewers and Peter Mourani and Kushner, {Jake A.} and Loftis, {Laura L.} and Monika Goyal and Rakesh Mistry and Vijay Srinivasan and Andrew Palladino and Wolfsdorf, {Joseph I.} and Agus, {Michael S.} and Linda Snelling and Charlotte Boney and Cogen, {Fran R.} and Sonali Basu and White, {Neil H.} and Kolovos, {Nikoleta S.} and Denise Goodman and Bennett, {Jonathan E.} and Doyle, {Daniel A.} and Frizzola, {Meg A.} and Kwok, {Maria Y.} and David Schnadower and Gallagher, {Mary Pat} and Baird, {John Scott}",
note = "Funding Information: FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose. FUNDING: Supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (grant U01HD062417) and the Emergency Medical Services for Children Network Development Demonstration Program of the Maternal and Child Health Bureau, Health Resources and Services Administration (under cooperative agreement awards U03MC00008, U03MC00001, U03MC00003, U03MC00006, U03MC00007, U03MC22684, and U03MC22685). Publisher Copyright: Copyright {\textcopyright} 2021 by the American Academy of Pediatrics",
year = "2021",
month = sep,
day = "1",
doi = "10.1542/peds.2021-050243",
language = "English",
volume = "148",
journal = "Pediatrics",
issn = "0031-4005",
number = "3",
}