Laboratory presentation in diabetic ketoacidosis and duration of therapy.

OBJECTIVE

To determine if initial emergency department (ED) laboratory parameters in children with diabetic ketoacidosis (DKA) can predict the minimum duration of continuous insulin therapy and aid in ED triage.

DESIGN

Retrospective chart review, over a four-year period.

SETTING

Tertiary care pediatric center ED.

PATIENTS

All patients in DKA, managed with a standard hospital protocol were included. Standard therapy consisted of an intravenous infusion over an hour of normal saline or Ringer's lactate, followed by 0.45% saline (potassium acetate/ phosphate added) at 1.5 times maintenance and insulin infusion (0.1 units/kg/h). New-onset diabetic patients were excluded.

MAIN RESULTS

One hundred thirty-two visits (45 patients, 55.5% female) were reviewed. Three of 60 (5%) patient-visits with moderate to severe DKA (serum pH < 7.20 and serum bicarbonate concentration < 10 mmol/L) had their acidosis corrected (serum pH > or = 7.30 or serum bicarbonate concentration > or = 15 mmol/L) within four hours compared to 33 of 72 (46%) patient-visits with mild DKA (serum pH > or = 7.20 or serum bicarbonate concentration > or = 10 mmol/L) (P < 0.0001). The acidosis was corrected within six hours in 69 and 11% of the mild and moderate-severe DKA group, respectively (P < 0.0001).

CONCLUSIONS

Initial laboratory presentation can help predict the minimum necessary duration of therapy in pediatric patient with DKA, aid early triage decision in the ED, and select a subgroup of patients who may be considered for outpatient management.