title: Effect of Volume of Fluid Resuscitation on Metabolic Normalization in Children Presenting in Diabetic Ketoacidosis: A Randomized Controlled Trial.
abstract: BACKGROUND
  The optimal rate of fluid administration in pediatric diabetic ketoacidosis (DKA) is unknown.
  
  
  OBJECTIVE
  Our aim was to determine whether the volume of fluid administration in children with DKA influences the rate of metabolic normalization.
  
  
  METHODS
  We performed a randomized controlled trial conducted in a tertiary pediatric emergency department from December 2007 until June 2010. The primary outcome was time to metabolic normalization; secondary outcomes were time to bicarbonate normalization, pH normalization, overall length of hospital treatment, and adverse outcomes. Children between 0 and 18 years of age were eligible if they had type 1 diabetes mellitus and DKA. Patients were randomized to receive intravenous (IV) fluid at low volume (10 mL/kg bolus + 1.25 × maintenance rate) or high volume (20 mL/kg bolus + 1.5 × maintenance rate) (n = 25 in each).
  
  
  RESULTS
  After adjusting for initial differences in bicarbonate levels, time to metabolic normalization was significantly faster in the higher-volume infusion group compared to the low-volume infusion group (hazard ratio [HR] = 2.0; 95% confidence interval [CI] 1.0-3.9; p = 0.04). Higher-volume IV fluid infusion appeared to hasten, to a greater extent, normalization of pH (HR = 2.5; 95% CI 1.2-5.0; p = 0.01) than normalization of serum bicarbonate (HR = 1.2; 95% CI 0.6-2.3; p = 0.6). The length of hospital treatment HR (0.8; 95% CI 0.4-1.5; p = 0.5) and time to discharge HR (0.8; 95% CI 0.4-1.5; p = 0.5) did not differ between treatment groups.
  
  
  CONCLUSIONS
  Higher-volume fluid infusion in the treatment of pediatric DKA patients significantly shortened metabolic normalization time, but did not change overall length of hospital treatment. ClinicalTrials.gov ID NCT01701557.
authors.affiliation: Department of Emergency Medicine, Denver Health Medical Center, University of Colorado, School of Medicine, Denver, Colorado.
authors.forename: Katherine
authors.initials: K
authors.lastname: Bakes
authors.affiliation: Department of Emergency Medicine, Denver Health Medical Center, University of Colorado, School of Medicine, Denver, Colorado; Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, Colorado.
authors.forename: Jason S
authors.initials: JS
authors.lastname: Haukoos
authors.affiliation: Department of Research Informatics, Children's Hospital Colorado, Research Institute, Aurora, Colorado.
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Deakyne
authors.affiliation: Department of Emergency Medicine, Denver Health Medical Center, University of Colorado, School of Medicine, Denver, Colorado.
authors.forename: Emily
authors.initials: E
authors.lastname: Hopkins
authors.affiliation: Department of Emergency Medicine, Denver Health Medical Center, University of Colorado, School of Medicine, Denver, Colorado.
authors.forename: Josh
authors.initials: J
authors.lastname: Easter
authors.affiliation: Colorado School of Public Health, University of Colorado, Aurora, Colorado.
authors.forename: Kim
authors.initials: K
authors.lastname: McFann
authors.affiliation: Section Emergency Medicine, Department of Pediatrics, University of Colorado, School of Medicine, Aurora, Colorado.
authors.forename: Alison
authors.initials: A
authors.lastname: Brent
authors.affiliation: Section Emergency Medicine, Department of Pediatrics, University of Colorado, School of Medicine, Aurora, Colorado.
authors.forename: Arleta
authors.initials: A
authors.lastname: Rewers
mesh_terms: D000293:Adolescent; D001639:Bicarbonates / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D002648:Child; D016883:Diabetic Ketoacidosis / Q000628:therapy*; D004636:Emergency Service, Hospital; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D016896:Treatment Outcome
chemical_list: D001639:Bicarbonates; D015415:Biomarkers
keywords: DKA; acidosis; bicarbonate; fluid resuscitation; ketoacidosis; ketones; pediatric diabetes