ESPE Abstracts

Aim: The ideal intravenous (iv) fluid administration rate in the treatment of diabetic ketoacidosis (DKA) and its effect on metabolic normalization, changes in electrolyte levels and the development of complications such as cerebral oedema are controversial in the paediatric age group. We aimto present the results of a practical and modified DKA treatment protocol, which was prepared with reference to the International Society for Paediatric and Adolescent Diabetes (ISPAD) and other international guidelines.

Method: 10-20 cc/kg/h isotonic sodium chloride followed by 3000 ml/m2/day fluid infusion (%09NaCl changed according to the glucose levels), regardless of the degree of dehydration and age, without the need to calculate daily fluid deficit and maintenance fluid requirement separately is used. From 2012 to 2024, 126 patients with DKA who did not require intensive care and whose complete data were available were retrospectively evaluated.

Results: Median age was 10 (1-18) years and 65 (51.6%) were female. Eighty-five (67.5%) patients had new onset T1D. At presentation, plasma glucose was 453±123 mg/dL, pH was 7.15±0.12 (7.19, 6.8-7.25) and HCO3 was 9.6±3.5 (9.4, 2.9-14.5) mmol/L. Ninety (71.5%) of the patients had mild/moderate and 36 (28.5%) had severe DKA. DKA recovery time was 11.3±8.3 hours. Recovery time was longer with increasing degree of acidosis (P <0.001). Hypophosphatemia (2.2±0.8 mg/dL) was the most common treatment-related electrolyte disturbance observed in 64 (50%) patients. Hypokalemia (2.9±0.3 mEq/L) was observed in 47 (37%) of the patients. None of the patients had DKA and/or treatment-related electrolyte disturbance clinic, deterioration in renal function, hypoglycemia, decrease in Glasgow Coma Scale score, brain oedema, permanent neurological damage, other rare complications or death.

Conclusion: The standard fluid infusion rate can be used safely and effectively in all DKA patients regardless of the degree of dehydration and age, without calculating the daily fluid deficit and maintenance fluid requirement. When compared with different studies, acidosis recovery time was faster without complications.