• Benjamin Edward Orwoll.
• Division of Pediatric Critical Care, Department of Pediatrics, University of California San Francisco Benioff Children's Hospitals, San Francisco and Oakland, CA.
• Pediatr Crit Care Me. 2016 Oct 1; 17 (10): e477-e480.

ObjectiveTo review the findings and discuss the implications of the use of low-dose insulin infusions in pediatric diabetic ketoacidosis compared with standard-dose insulin.Data SourcesA search of the electronic PubMed database was used to perform the clinical query as well as to search for additional relevant literature.Study Selection And Data ExtractionThe article by Nallasamy K et al "Low-Dose vs Standard-Dose Insulin in Pediatric Diabetic Ketoacidosis: A Randomized Clinical Trial. JAMA Pediatrics 2014; 17:e477-e480" was selected for critical appraisal and literature review.Data SynthesisThe authors performed a randomized controlled trial among 50 consecutive patients of 0-12 years old presenting to the emergency department in diabetic ketoacidosis. They found that low-dose (0.05 U/kg/hr) insulin infusion was noninferior to standard-dose (0.1 U/kg/hr) insulin in terms of resolution of hyperglycemia and acidosis with a trend toward lower rates of therapy-related complications in the low-dose group.ConclusionsLow-dose insulin infusion is noninferior to standard-dose insulin in the treatment of younger pediatric patients with diabetic ketoacidosis and may lead to fewer therapy-related complications.

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