Clinical and Laboratory Predictors of Dehydration Severity in Children With Diabetic Ketoacidosis

Authors

Jennifer L Trainor
Nicole S Glaser
Leah Tzimenatos
Michael J Stoner
Kathleen M Brown
Julie K McManemy
Jeffrey E Schunk
Kimberly S Quayle
Lise E Nigrovic
Arleta Rewers
Sage R Myers
Jonathan E Bennett
Maria Y Kwok
Cody S Olsen
T Charles Casper
Simona Ghetti
Nathan Kuppermann
Pediatric Emergency Care Applied Research Network (PECARN) FLUID Study Group

Publication Date

8-1-2023

Journal

Annals of Emergency Medicine

DOI

10.1016/j.annemergmed.2023.01.001

PMID

37024382

PMCID

PMC10523885

PubMedCentral® Posted Date

8-1-2024

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes

Keywords

Child, Humans, Diabetic Ketoacidosis, Dehydration, Cohort Studies, Fluid Therapy, Hypertension, Retrospective Studies, Diabetes Mellitus

Abstract

STUDY OBJECTIVE: Our primary objective was to characterize the degree of dehydration in children with diabetic ketoacidosis (DKA) and identify physical examination and biochemical factors associated with dehydration severity. Secondary objectives included describing relationships between dehydration severity and other clinical outcomes.

METHODS: In this cohort study, we analyzed data from 753 children with 811 episodes of DKA in the Pediatric Emergency Care Applied Research Network Fluid Therapies Under Investigation Study, a randomized clinical trial of fluid resuscitation protocols for children with DKA. We used multivariable regression analyses to identify physical examination and biochemical factors associated with dehydration severity, and we described associations between dehydration severity and DKA outcomes.

RESULTS: Mean dehydration was 5.7% (SD 3.6%). Mild (0-<5%), moderate (5-<10%), and severe (≥10%) dehydration were observed in 47% (N=379), 42% (N=343), and 11% (N=89) of episodes, respectively. In multivariable analyses, more severe dehydration was associated with new onset of diabetes, higher blood urea nitrogen (BUN), lower pH, higher anion gap, and diastolic hypertension. However, there was substantial overlap in these variables between dehydration groups. Mean length of hospital stay was longer for patients with moderate and severe dehydration, both in new onset and established diabetes.

CONCLUSION: Most children with DKA have mild-to-moderate dehydration. Although biochemical measures were more closely associated with the severity of dehydration than clinical assessments, neither were sufficiently predictive to inform rehydration practice.