• Nese Akcan, Metin Uysalol, Ibrahim Kandemir, Didem Soydemir, Zehra Yavas Abali, Sukran Poyrazoglu, Firdevs Bas, Ruveyde Bundak, and Feyza Darendeliler.
• From the Department of Pediatric Endocrinology, Faculty of Medicine, Near East University, Nicosia, Cyprus.
• Pediatr Emerg Care. 2021 Nov 1; 37 (11): e707e712e707-e712.

ObjectiveManagement protocols for pediatric diabetic ketoacidosis (DKA) vary considerably among medical centers. The aim of this study was to investigate the efficacy and safety of 3 different fluid protocols in the management of DKA.MethodsFluid management protocols with sodium contents of 75, 100, and 154 mEq/L NaCl were compared. In all groups, after the initial rehydration, the protocols differed from each other in terms of the maintenance fluid, which had different rates of infusion and sodium contents. Clinical status and blood glucose levels were checked every hour during the first 12 hours. Biochemical tests were repeated at 2, 6, 12, 24, and 36 hours.ResultsThe medical records of 144 patients were evaluated. Cerebral edema developed in 18% of the patients. The incidence of cerebral edema was lowest in the group that received fluid therapy with a sodium content of 154 mEq/L NaCl at least 4 to 6 hours and had a constant rate of infusion for 48 hours. The patients with cerebral edema had lower initial pH and HCO3 and severe dehydration with higher initial plasma osmolality. There was no significant difference between the groups in terms of the recovery times of blood glucose, pH, HCO3, and the time of transition to subcutaneous insulin therapy.ConclusionsSeverity of acidosis and dehydration are associated with the development of cerebral edema. It can be concluded that fluid therapy with higher Na content and a constant maintenance rate may present less risk for the patient with DKA.Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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