Paper Chase 2 – Fluid Volume in Pediatric DKA

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Nurses Edition Commentary

Mizuho Spangler, DO, Lisa Chavez, RN, and Kathy Garvin, RN
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Katherine B. -

I am a little surpised that increasing the volume of NS resulted in improved metabolic derangement. The ICU attendings where I work encourage the use of LR, because there is almost always a hyperchloremic acidosis which occurs when using NS. I now almost exclusively use LR because I have found this to be true. Maybe the acidosis improved in these children secondary to profound dehydration? Thoughts?

Mike J., M.D. -

Ok, realize that these kids, (and adults) did not become volume deplete and develop DKA in hours, why do we feel the need to fix them in hours. Large datasets of patients with volume depletion (the FEAST study) have demonstrated that overaggressive bolus resuscitation is associated with poor outcome. I don't think a 50 patient study is going to change my management of these patients, adult or children.

They didn't get sick in hours, we don't need to fix them in hours.

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