title: Challenging the One-Dose-Fits-All Model for Insulin in the Acute Treatment of Pediatric Diabetic Ketoacidosis. A Critical Appraisal of "Low-Dose Versus Standard-Dose Insulin in Pediatric Diabetic Ketoacidosis: A Randomized Clinical Trial" by Nallasamy et al (JAMA Pediatrics 2014; 168:999-1005).
abstract: To review the findings and discuss the implications of the use of low-dose insulin infusions in pediatric diabetic ketoacidosis compared with standard-dose insulin.
  
  
  
  A search of the electronic PubMed database was used to perform the clinical query as well as to search for additional relevant literature.
  
  
  
  The 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.
  
  
  
  The 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.
  
  
  
  Low-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.
authors: Division of Pediatric Critical Care, Department of Pediatrics, University of California San Francisco Benioff Children's Hospitals, San Francisco and Oakland, CA.
authors: Benjamin Edward
authors: BE
authors: Orwoll
mesh_terms: D002648:Child; D016208:Databases, Factual; D016883:Diabetic Ketoacidosis; D004636:Emergency Service, Hospital; D006801:Humans; D006943:Hyperglycemia; D007328:Insulin
chemical_list: D007328:Insulin