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. 2021 Mar;10(1):23-30.
doi: 10.1055/s-0040-1712921. Epub 2020 Jun 4.

Implementation of an Intravenous Fluid Titration Algorithm to Treat Pediatric Diabetic Ketoacidosis

Christopher Babbitt  1 , Marc Dadios  2 , Ariya Chau  3 , Graham Tse  1 , Lisa Brown  1 , Tracy Ladbury  1 , Tricia Morphew  4   5 , Mario Brakin  6
Affiliations

Implementation of an Intravenous Fluid Titration Algorithm to Treat Pediatric Diabetic Ketoacidosis

Christopher Babbitt et al. J Pediatr Intensive Care. 2021 Mar.

Abstract

Diabetic ketoacidosis (DKA) is a common cause of admission to the pediatric intensive care unit and many centers utilize the "two-bag system" to treat DKA. We developed an intravenous fluid (IVF) titration algorithm to standardize adjustments of the two bags. A retrospective cohort study was performed comparing 155 patients treated before and 175 patients treated after implementation of the IVF titration algorithm. Postimplementation patients reached the blood glucose target zone faster and had a higher probability of remaining at goal while on insulin infusion. There was no significant difference in incidence of cerebral edema or hypoglycemia between study groups. Overall IVF titration algorithm compliance was 95%. Implementation of an IVF titration algorithm is safe and effective when treating DKA in children.

Keywords: diabetes; insulin; ketoacidosis.

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Conflict of interest statement

Conflict of Interest T.M. has a consulting arrangement with Memorial Health Services that provided financial support for research and statistical analyses on this study. The rest authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
The pediatric DKA fluid titration algorithm. DKA, diabetic ketoacidosis.
Fig. 2
Fig. 2
Average BG levels from ED presentation through hour 20 of insulin infusion. BGNS is the BG level after the initial normal saline bolus. BG0 is the BG immediately prior to starting the insulin infusion. Estimates produced using GEE analyses with normal distribution specified and AR1 correlation structure. Final model includes the following terms: time, group (A or B), initial rate (0.05 or 0.10), new onset (yes or no), and PRISM III score. BG, blood glucose; BGNS, blood glucose post normal saline bolus; ED, emergency department; GEE, general estimating equation; PRISM, Pediatric Risk of Mortality.
Fig. 3
Fig. 3
Probability patient in target zone (BG: 100–200 mg/dL) from initiation of treatment algorithm through hour 20 on insulin infusion. Estimates produced using GEE analyses with binomial distribution specified and AR1 correlation structure. Final model includes the following terms: hour, group (A or B), initial rate (0.05 or 0.10), new onset (yes or no), and PRISM III score. BG, blood glucose; GEE, general estimating equation; PRISM, Pediatric Risk of Mortality.
Fig. 4
Fig. 4
Average dextrose percentage while on insulin infusion. Estimates produced using GEE analyses with gamma distribution specified and AR1 correlation structure. Final model includes the following terms: time, group (A or B), initial rate (0.05 or 0.10), new onset (yes or no), PRISM III score, and hour group. GEE, general estimating equation; PRISM, Pediatric Risk of Mortality.
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