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Randomized Controlled Trial
. 2023 Aug;82(2):167-178.
doi: 10.1016/j.annemergmed.2023.01.001. Epub 2023 Apr 5.

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

Jennifer L Trainor  1 , Nicole S Glaser  2 , Leah Tzimenatos  3 , Michael J Stoner  4 , Kathleen M Brown  5 , Julie K McManemy  6 , Jeffrey E Schunk  7 , Kimberly S Quayle  8 , Lise E Nigrovic  9 , Arleta Rewers  10 , Sage R Myers  11 , Jonathan E Bennett  12 , Maria Y Kwok  13 , Cody S Olsen  7 , T Charles Casper  7 , Simona Ghetti  14 , Nathan Kuppermann  15 ; Pediatric Emergency Care Applied Research Network (PECARN) FLUID Study Group
Collaborators, Affiliations
Randomized Controlled Trial

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

Jennifer L Trainor et al. Ann Emerg Med. 2023 Aug.

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 to <5%), moderate (5 to <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, lower pH, higher anion gap, and diastolic hypertension. However, there was substantial overlap in these variables between dehydration groups. The 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.

Trial registration: ClinicalTrials.gov NCT00629707.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Kuppermann reported receiving personal fees from InsuCalc outside the submitted work. No other disclosures were reported.

Figures

Figure 1:
Figure 1:
Study participants after exclusions
Figure 1a.
Figure 1a.
(Online only) Area under the receiver operating characteristic curve (AUC) of severe vs. mild or moderate dehydration and predictors: heart rate, systolic blood pressure, diastolic blood pressure, capillary refill time (≥2 vs <2 seconds), BUN, creatinine, glucose-corrected sodium, pH, pCO2, glucose, and anion gap.
Figure 2:
Figure 2:
Associations between estimated probabilities of mild, moderate, and severe dehydration and biochemical variables in children with new-onset and previously diagnosed diabetes. Estimated probabilities are ploted as circles Lines presented the expected probablity assuming mean values of all other covariates Pointwise 95% confidence limits are shown as shaded regions
See this image and copyright information in PMC

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