Fluid regimes for DKA

Diabetic ketoacidosis (DKA) can be challenging to manage. In the vast majority the outcome is good, but in a few cerebral oedema can develop rapidly and unpredictably, resulting in neurological impairment and, occasionally, death. It is more common in children than adults, and its pathophysiology has traditionally been attributed to rapid changes in blood osmolality causing fluid to shift into brain cells. For these reasons, recommended intravenous rehydration regimes for  children have differed from those for adults, using lower rates and volumes, and isotonic rather than hypotonic solutions.

This has been challenged recently, with a suggestion that the oedema is more due to vascular endothelial leakage following reperfusion injury, and nothing to do with osmosis. In a large multi-centre randomised controlled trial from the US, around 1300 children under 18 presenting with DKA (blood glucose >16.7 mmol/L and either pH <7.25 or bicarbonate <15 mmol/L) were randomised to one of four groups: 0.45% saline with...

from Archives of Disease in Childhood current issue https://ift.tt/2MvLcJU