Written by Rebecca White
Most pediatric patients with diabetic ketoacidosis (DKA) have mild to moderate dehydration. Clinical and laboratory variables in isolation are not accurate predictors of rehydration needs.
Why does this matter?
Determining dehydration severity and therefore fluid replacement needs in children with DKA is challenging, but important; appropriate hydration strategies may reduce rates of serious complications. Can we use clinical or laboratory features to determine dehydration severity?
In this multicenter cohort study and secondary analysis, 753 pediatric patients with 811 episodes of DKA who were enrolled in the PECARN FLUID Trial, a randomized clinical trial for fluid resuscitation strategies in DKA, were included. Multivariable regression analyses were used to identify physical exam and biochemical variables associated with severity of dehydration and the association with DKA outcomes. Percent dehydration was calculated based on the change in body weight from admission to discharge.
Mean dehydration was 5.7% (SD 3.6%). Mild (0 to <5%), moderate (5 to <10%), and severe (≥10%) dehydration were seen in 47% (N = 379), 42% (N = 343), and 11% (N = 89) of cases. More severe dehydration was associated with new onset diabetes, higher blood urea nitrogen, lower pH, higher anion gap, and diastolic hypertension. However, there was considerable overlap in these variables between groups. Average hospital stay was longer in patients with moderate and severe dehydration compared to mild, both in new and established diabetics.
Clinical and Laboratory Predictors of Dehydration Severity in Children With Diabetic Ketoacidosis. Ann Emerg Med. 2023 Apr 4;S0196-0644(23)00002-1. doi: 10.1016/j.annemergmed.2023.01.001. Online ahead of print.