• Said Al Hanshi and Frank Shann.
• Pediatric Intensive Care Unit, The Royal Hospital, Sultanate of Oman.
• Pediatr Crit Care Me. 2011 Mar 1;12(2):137-40.

ObjectiveTo compare the effects of infusing insulin at 0.05 units/kg/hr rather than 0.1 units/kg/hr in children admitted to the intensive care unit with diabetic ketoacidosis.DesignA retrospective observational study.SettingA tertiary pediatric intensive care unit.PatientsAll children with diabetic ketoacidosis admitted during the 6-yr period from 2000 to 2005.InterventionsNone.Measurements And Main ResultsThe effective plasma osmolality (plasma glucose concentration in mmol/L + twice the plasma sodium concentration in mmol/L), plasma glucose, plasma sodium, fluid intake, and acid-base status 12 hrs after the commencement of the insulin infusion. Compared to the 34 children who received 0.1 units/kg/hr of insulin, the 33 children who received 0.05 units/kg/hr of insulin were younger (median age, 25 mos vs. 62 mos, p = .024) and had a more gradual reduction in the effective plasma osmolality over the first 12 hrs (p < .0005); this was because plasma glucose decreased more slowly (p = .004) and plasma sodium increased faster (p < .0005). Both groups had a satisfactory improvement in acidosis and ketosis, and they had a similar length of stay in the intensive care unit.ConclusionsFurther studies are needed to evaluate the role of using 0.05 units/kg/hr of insulin to treat children with diabetic ketoacidosis. The smaller dose of insulin may make it easier to lower the effective plasma osmolality gradually and might, therefore, reduce the risk of cerebral edema.

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