EMedHome's Clinical Pearl
The optimal fluid treatment protocol for children with diabetic ketoacidosis has long been a subject of controversy, but the PECARN DKA FLUID trial provided the first high-quality data of the effects of fluid infusion rates on neurological outcomes of children with DKA. (N Engl J Med 2018;378:2275; http://bit.ly/2EqsEG1.)
The trial data suggest that IV fluids should not be restricted unnecessarily because of concerns about causing brain injuries. Children with DKA should receive fluid resuscitation similar to children with other conditions involving similar degrees of dehydration. Findings from the FLUID trial provide evidence that rapid fluid infusion does not cause brain injury (within the range of infusion rates evaluated). (N Engl J Med 2018;378:2275; http://bit.ly/2EqsEG1; Pediatr Diabetes 2019;20:10; http://bit.ly/2IJae7N.)
Subanalyses in children with the most severe DKA also suggested more rapid improvements in mental status with more rapid fluid infusion rates. Most if not all children with DKA require a fluid bolus of 20 mL/kg, and additional fluid boluses should be administered if peripheral perfusion remains poor or other clinical signs of circulatory compromise are present after the initial fluid bolus.
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