ESPE Abstracts

Introduction: DKA is the most common cause of hospitalization, morbidity, and death in children with T1DM. Based on the International Society of Pediatric and Adolescent Diabetes (ISPAD) 2022, the biochemical criteria of DKA are: hyperglycemia (blood glucose >200 mg/dL), acidosis (venous pH <7.3 or bicarbonate <18 mmol/L), and ketonemia or moderate/large ketonuria. The principles of ABC (airway, breathing, circulation, and fluid resuscitation) are the first things to be applied while treating DKA patients. Fluid administration to restore the volume of the intravascular, interstitial, and intracellular compartments, is crucial and should be done immediately but with great care to avoid the risk of cerebral edema. However, until now there has been ongoing deliberation regarding fluid treatment strategy compared to the others. Therefore, to discover the best management and outcome for the patients, a systematic review of fluid selection in managing diabetic ketoacidosis in children is required.

Material and Methods: Literature search was performed using keywords with a combination of Boolean connectors (“CHILDREN” OR “PEDIATRIC”) AND (“DIABETIC KETOACIDOSIS”) AND (“FLUID”) with various combinations. The systematic review was carried out based on the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. The authors used articles from PubMed database. The studies included were limited to articles published in the last 10 years (2013–2023), in English, included children aged 0–18 years with DKA. The exclusion criteria were research using qualitative methods, abstracts from national/international conferences, guidelines, case reports, commentaries, and review articles. All studies which met the criteria were identified using the selected keywords. Then, title screening was done, followed by abstract screening. Complete article screening was done on studies that met the inclusion criteria and did not meet the exclusion criteria. The main outcomes assessed were time to resolution of ketoacidosis, adverse events, duration of hospitalization, and cost.

Conclusion: The evidence to date does not support the use of one over the other options of intravenous fluids for the treatment of DKA: 0.9% saline, 0.45% saline, Ringer’s lactate, Plasma-Lyte, Hypertonic saline. Balanced crystalloid solutions were thought to be superior due to their alkalizing properties, available evidence did not show any clinical benefits over their use compared with normal saline. Although the use of hypertonic saline carries the risk of initial hyperchloremia, there was no significant difference in the incidence of Acute Kidney Injury and development of cerebral edema in comparison with NS.