Diabetes ketoacidosis recovery in youth with newly diagnosed and established type 1 diabetes

Smuel-Zilberberg, Keren; Shalitin, Shlomit; Yackobovitch‐Gavan, Michal; Phillip, Moshe; Nimri, Revital

doi:10.1038/s41390-021-01618-z

Cited by 2 publications

(1 citation statement)

References 36 publications

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“…Data were extracted from the medical records at admission, including age, sex and biochemistry (glucose, sodium, potassium, urea, creatinine, pH, bicarbonate and partial carbon dioxide pressure). Acidosis recovery time (time to resolution of acidosis) was determined as the duration from the initiation of the NS bolus to pH >7.3 and bicarbonate >15 mEq/l, in blood gas analysis [ 11 ].…”

Section: Methodsmentioning

confidence: 99%

Revised one-bag IV fluid protocol for pediatric DKA: a feasible approach and retrospective comparative study

Doğan,

Gökalp,

Eren

et al. 2024

Journal of Tropical Pediatrics

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Background This study compared the effectiveness of the traditional and revised one-bag protocols for pediatric diabetic ketoacidosis (DKA) management. Methods This single-center retrospective cohort study included children diagnosed with DKA upon admission between 2012 and 2019. Our institution reevaluated and streamlined the traditional one-bag protocol (revised one-bag protocol). The revised one-bag protocol rehydrated all pediatric DKA patients with dextrose (5 g/100 ml) containing 0.45% NaCl at a rate of 3500 ml/m2 per 24 h after the first 1 h bolus of normal saline, regardless of age or degree of dehydration. This study examined acidosis recovery times and the frequency of healthcare provider interventions to maintain stable blood glucose levels. Results The revised one-bag protocol demonstrated a significantly shorter time to acidosis recovery than the traditional protocol (12.67 and 18.20 h, respectively; p < 0.001). The revised protocol group required fewer interventions for blood glucose control, with an average of 0.25 dextrose concentration change orders per patient, compared to 1.42 in the traditional protocol group (p < 0.001). Insulin rate adjustments were fewer in the revised protocol group, averaging 0.52 changes per patient, vs. 2.32 changes in the traditional protocol group (p < 0.001). Conclusion The revised one-bag protocol for pediatric DKA is both practical and effective. This modified DKA management achieved acidosis recovery more quickly and reduced blood glucose fluctuations compared with the traditional one-bag protocol. Future studies, including randomized controlled trials, should assess the safety and effectiveness of the revised protocol in a broad range of pediatric patients with DKA.

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Section: Methodsmentioning

confidence: 99%

Revised one-bag IV fluid protocol for pediatric DKA: a feasible approach and retrospective comparative study

Doğan,

Gökalp,

Eren

et al. 2024

Journal of Tropical Pediatrics

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Serum Phosphorus and Hypophosphatemia During Therapy of Diabetic Ketoacidosis in Children: Single-Center, Retrospective Cohort 2016–2022

Hasan,

Hesen,

Millican

et al. 2024

Pediatric Critical Care Medicine

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Objectives: To assess factors associated with serum phosphorus (P) and hypophosphatemia in children with type 1 diabetes mellitus (T1DM) treated for diabetic ketoacidosis (DKA). Design: Retrospective cohort. Setting: Community-based PICU in a university-affiliated hospital. Patients: Patients 1–20 years old with T1DM hospitalized for DKA from July 1, 2016, to July 31, 2022. Interventions: None. Measurements and Main Results: We collected age, sex, duration of T1DM, conscious state at presentation, and most recent glycohemoglobin level. P was tested initially and then every 4 hours. Probability of hypophosphatemia and time to hypophosphatemia and hospital length of stay (LOS) were analyzed via binomial and linear mixed-effects regression analyses, respectively. A total of 852 DKA episodes occurred in 365 patients (46.3% female, median age 14.7 yr), of which 158 (18.5%) episodes were new-onset T1DM. Hypophosphatemia developed during 656 of 852 (77%) episodes, including 49 of 852 (5.8%) episodes of severe hypophosphatemia with median (interquartile range) onset 8.0 hours (4.7–11.9 hr) and 12.0 hours (8.1–17.6 hr), respectively, following initiation of therapy. Higher glycohemoglobin was associated with greater odds of hypophosphatemia (odds ratio [OR], 1.22; p < 0.001). However, lower odds of hypophosphatemia were associated with older age (OR, 0.89; p < 0.01), male (OR, 0.11; p = 0.01), longer T1DM duration (OR, 0.87; p < 0.001), and having initial normal conscious state (OR, 0.18; p < 0.01). Older age (3.0%/yr; p = 0.02), T1DM duration (4.1%/yr; p = 0.01), and initial serum P (23.4%/mg/dL; p < 0.001) were associated with later hypophosphatemia. LOS was shorter with increased T1DM duration (3.6%/yr; p < 0.001) and normal conscious state (33.1% shorter; p < 0.001), but longer with increasing glycohemoglobin (4.0%; p < 0.001). All patients survived with normal neurologic function. Conclusions: Higher glycohemoglobin was associated with greater odds of hypophosphatemia and longer LOS. Older male, longer duration of T1DM, and conscious at admission were factors associated with lower odds of developing hypophosphatemia and with later onset when it occurred. Hypophosphatemia was associated with longer LOS.

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Diabetes ketoacidosis recovery in youth with newly diagnosed and established type 1 diabetes

Cited by 2 publications

References 36 publications

Revised one-bag IV fluid protocol for pediatric DKA: a feasible approach and retrospective comparative study

Revised one-bag IV fluid protocol for pediatric DKA: a feasible approach and retrospective comparative study

Serum Phosphorus and Hypophosphatemia During Therapy of Diabetic Ketoacidosis in Children: Single-Center, Retrospective Cohort 2016–2022

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