Resolution of ketoacidosis in children with new onset diabetes: Evaluation of various definitions. (January 2018)

• Record Type: Journal Article
• Authors: von Oettingen, Julia E.; Rhodes, Erinn T.; Wolfsdorf, Joseph I.
• Is Part Of: Diabetes research and clinical practice. Volume 135(2018)
• Page Start: 76
• Page End: 84
• Publication Date: 2018-01
• Subjects: Diabetic ketoacidosis -- Acid-base equilibrium -- Blood gas analysis -- Bicarbonate -- Child; Diabetes -- Periodicals; Diabetes Mellitus -- Periodicals; 616.462
• DOI: 10.1016/j.diabres.2017.09.011
• Languages: English
• ISSNs: 0168-8227

Abstract

Highlights: Blood gas analyzers may not be available in resource-limited settings. Electrolyte parameters alone can be used to monitor DKA resolution. In DKA, serum bicarbonate >15 mmol/L best correlates with the composite of vpH ≥ 7.3 and anion gap ≤ 18 mmol/L. In moderate and severe DKA, anion gap normalizes before vpH reaches 7.3. Abstract: Aims: Data are sparse concerning use of serum electrolyte parameters as compared to venous blood gas (VBG) measurements to monitor acid-base status during treatment of diabetic ketoacidosis (DKA). We explored the utility of various parameters to define DKA resolution by investigating the relationship of venous pH (vpH), anion gap (AG), serum bicarbonate (HCO3 ), and glucose concentration during management of DKA in children with new onset diabetes mellitus (NODM). Methods: We included all patients with NODM presenting with DKA to Boston Children's Hospital from 10/1/07–7/1/13. DKA was defined as serum glucose ≥ 200 mg/dL (11.1 mmol/L) and vpH < 7.30; severity as mild < 7.30, moderate < 7.20, severe < 7.10; resolution of DKA as vpH ≥ 7.30 and AG ≤ 18 mmol/L. We used Cox regression to determine time to DKA resolution, and logistic regression to evaluate different serum HCO3 cut-off values as predictors of DKA resolution. Results: 263 patients (133F, mean age 9.9 ± 4.4 years, 74% White) were included. DKA was mild in 134 (51%), moderate in 75 (28%) and severe in 54 (20%). In mild DKA, AG closed after normalization of vpH; in moderate and severe DKA, AG closed before normalization of vpH. HCO3 > 15 mmol/L correlated with vpH ≥ 7.30, and had 76% sensitivity and 85% specificity to predict DKA resolution. Median times to DKA resolution were similar using two different definitions: vpH and AG (8.4 h [IQR 6.3–11.9]) vs. HCO3 > 15 mmol/L (7.9 h [IQR 5.0–11.8]), p = .42. Conclusions: During management of pediatric DKA, HCO3 > 15 mmol/L reliably predicts resolution of DKA. In low-resource settings where VBG is unavailable, electrolyte parameters alone may be used to determine DKA resolution.