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J Pediatr Intensive Care 2021; 10(01): 023-030
DOI: 10.1055/s-0040-1712921
Original Article

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

Christopher Babbitt 
1   Division of Pediatric Critical Care, Miller Children's and Women's Hospital Long Beach, Long Beach, California, United States
,
Marc Dadios 
2   Division of Pediatric Critical Care, Children's Hospital of Orange County, Orange, California, United States
,
Ariya Chau
3   Division of Pediatric Critical Care, Children's Hospital of Los Angeles, Los Angeles, California, United States
,
Graham Tse
1   Division of Pediatric Critical Care, Miller Children's and Women's Hospital Long Beach, Long Beach, California, United States
,
Lisa Brown
1   Division of Pediatric Critical Care, Miller Children's and Women's Hospital Long Beach, Long Beach, California, United States
,
Tracy Ladbury
1   Division of Pediatric Critical Care, Miller Children's and Women's Hospital Long Beach, Long Beach, California, United States
,
Tricia Morphew
4   Morphew Consulting LLC, Bothell, Washington, United States
5   MemorialCare Health System, Fountain Valley, California, United States
,
Mario Brakin
6   Division of Pediatric Endocrinology, Miller Children's and Women's Hospital Long Beach, Long Beach California, United States
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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


Publication History

Received: 10 February 2020

Accepted: 23 April 2020

Article published online:
04 June 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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