Effects of Rapid Intravenous Rehydration in Children With Mild-to-Moderate Dehydration

Hahn

Acta Anaesthesiol Scand

2018

Section: Introductionmentioning

confidence: 99%

Recruitment of extravascular fluid by hyperoncotic albumin

Hahn

Acta Anaesthesiol Scand

2018

“…8 The median ketone level in our cohort was higher than demonstrated by Levy et al and Janet et al (4.4 mmol/L versus 3.1 mmol/L and 1.5 mmol/L, respectively). 6,9 In our study, 73% of patients had a POC ketone levels >3 mmol/L and blood testing showed features of acidosis in 46% (n=38/83) (blood pH <7.3 or plasma bicarbonate <18 mmol/L). The cohort's hospital admission rate (30%) was noticeably elevated compared to our baseline admission rate for children with the ED diagnosis of gastroenteritis (20%) which reflects the selective inclusion criteria which isolated children with clinically significant manifestation of symptoms.…”

Section: Discussionmentioning

confidence: 45%

“…This decrease is similar to the decrease of 0.2 mmol/L/hr noted by Janet et al in children rehydrated with 20 mL/kg over 2 hours of normal saline and 2.5% dextrose followed by 120 mL of oral rehydration solution. 6 There is no international consensus for the optimal rehydration fluids in children. 19 We believe that the significance of ketosis in the presentation of acute paediatric illness and the potential for tailored treatments in paediatric acute illness warrants further research.…”

Section: Discussionmentioning

confidence: 99%

“…There is limited research looking at the usage of POC ketone testing in children without diabetes. [6][7][8][9][10] O'Donohoe et al reported that POC ketones were useful in determining the risk of admission based on a cohort of 186 pediatric ED patients (0 to 13 years) who required blood testing. 7 O'Donohoe et al proposed that ketone levels >1.2 mmol/L as a predictor for admission based on a specificity of 86%, a sensitivity of 32% and a positive predicted value of 67%.…”

Section: Introductionmentioning

confidence: 99%

“…8 Janet et al demonstrated a reduction in median ketone level from 1.5 to 0.8 mmol/L in 56 children aged 6 months to 16 years with mild to moderate dehydration who had rapid IV rehydration with 2.5% dextrose and normal saline for 2 hours. 6 Futatani et al described the potential usefulness of POC ketones in breastfeeding infants in the early postnatal period as an indicator of dehydration, energy depletion and acid-base imbalance. 10 The clinical assessment of dehydration in children is challenging.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The utility of ketones at triage: a prospective cohort study

et al. 2020

ObjectiveTo establish the relationship between serum point-of-care (POC) ketones at triage and moderate-to-severe dehydration based on the validated Gorelick Scales.Design, setting and patientsProspective unblinded study from April 2016 to February 2017 in a paediatric emergency department. Patients aged 1 month to 5 years, with vomiting and/or diarrhoea and/or decreased intake with signs of moderate or severe dehydration or clinical concern for hypoglycaemia were eligible.Main outcome measuresThe primary outcome was to describe the relationship between triage POC ketones to the two Gorelick Scales. Secondary outcomes were to examine the response of ketone levels to fluid/glucose administration and patient disposition.ResultsOne-hundred and ninety-eight patients were included; median age 1.8 years. The median triage ketones were 4.6 (IQR 2.8–5.6) mmol/L. A weak correlation was identified between triage ketones and the 10-point Gorelick Scale (Spearman’s ρ=0.217, p=0.002), however no correlation between triage ketones and the 4-point Gorelick Scale was identified. Those admitted had median triage ketones of 5.2 (IQR 4–6) mmol/L and repeat ketones of 4.6 (IQR 3.3–5.7) mmol/L compared with 4.2 (IQR 2.4–5.3) mmol/L and 2.9 (IQR 1.6–4.2) mmol/L in those discharged home.ConclusionNo correlation between triage POC ketones and the 4-point Gorelick Scale was established. POC ketones at triage have poor accuracy for predicting hospital admission. The elevated profile of POC ketones in non-diabetic children with acute illness suggests a potential target of tailored treatments for further research.

Alterations and diagnostic performance of capillary ketonemia in pediatric acute appendicitis: a pilot study

et al. 2022

Introduction The diagnostic performance of capillary ketonemia (CK) has been previously evaluated in context of pediatric acute gastroenteritis. To our knowledge, there is no literature on its performance in the setting of pediatric acute appendicitis (PAA). Materials and methods In this study, 151 patients were prospectively included and divided into two groups: (1) patients with non-surgical abdominal pain in whom the diagnosis of PAA was excluded (n = 53) and (2) patients with a confirmed diagnosis of PAA (n = 98). In 80 patients (Group 1, n = 23 and group 2, n = 57) a CK was measured at the time of diagnosis. The PAA group was further classified into complicated (n = 18) and uncomplicated PAA (n = 39). Quantitative variables were compared between groups using the Mann–Whitney U test. Diagnostic performance of CK was evaluated with ROC curves. Results CK values were 0.3 [0.1–0.9] mmol/L in group 1 and 0.7 [0.4–1.4] mmol/L in group 2 (p = 0.01). Regarding the type of PAA, CK values were 0.6 [0.4–0.9] mmol/L in uncomplicated PAA and 1.2 [0.8–1.4] mmol/L in complicated PAA (p = 0.02). The AUC for the discrimination between groups 1 and 2 was 0.68 (95% IC 0.53–0.82) (p = 0.24) and the AUC for the discrimination between uncomplicated PAA and complicated PAA was 0.69 (95% IC 0.54–0.85) (p = 0.04). The best cut-off point (group 1 vs group 2) resulted in 0.4 mmol/L, with a sensitivity of 80.7% and a specificity of 52.2%. The best cut-off point (non-complicated vs complicated PAA) resulted in 1.1 mmol/L, with a sensitivity of 61.1% and a specificity of 76.9%. Conclusions This study found significantly higher levels of CK in patients with PAA than in those with NSAP. Similarly, significantly higher levels were observed in patients with complicated than in those with uncomplicated PAA. Nevertheless, the diagnostic performance of CK was only moderate in the two settings analyzed. The potential usefulness of CK determination as a tool to guide the preoperative rehydration regimen of patients with PAA to prevent postoperative hyporexia and vomiting is a promising line of research and should be evaluated in future studies.