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BP Not a Reliable Indicator for Fluid Administration during Pediatric DKA

doi: 10.1097/01.EEM.0000697724.37317.a8


    Hypertension is frequent in children with diabetic ketoacidosis despite intravascular volume depletion. Factors associated with hypertension include greater severity of acidosis and lower PCO2 and GCS scores. (J Pediatr. 2020;S0022-3476[20]:30570.)

    A recent study of 1258 DKA episodes documented hypertension at presentation in 154 (12%) patients. (J Pediatr. 2020;S0022-3476[20]:30570.) It also developed during DKA treatment in an additional 196 (16%) patients, resulting in 350 DKA episodes (28%). The pathophysiology of this paradoxical hypertension is not understood.

    Blood pressure regulation during DKA appears to be influenced by factors other than intravascular volume. The important point is that physicians should not rely on blood pressure measurements in decision-making about fluid administration. (Pediatr Emerg Care. 2013;29[1]:82; Pediatr Diabetes. 2011;12[4 Pt 1]:295.) Instead, other factors such as heart rate, clinical assessment of peripheral perfusion, trends in laboratory indicators of circulatory volume (BUN and hematocrit), and careful monitoring of fluid intake and output should be used to guide treatment decisions.

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