Fluid Management for Critically Unwell Children with Diabetic Ketoacidosis: A Multi-centre Study

Abstract Background:Cerebral oedema in paediatric diabetic ketoacidosis (DKA) can be associated with significant mortality and morbidity. These concerns have led to restrictive fluid management in children presenting with DKA and also led to the revision of guidance by the British Society of Paediatric Endocrinology and Diabetes (BSPED) in 2015. Methods:We conducted a multi-centre study of compliance with two BSPED guidelines with liberal (2009) and restrictive fluid management (2015) protocols for children admitted to paediatric critical care units (PCCU) in the UK. We also used univariate and multivariate logistic regressions to study associations with clinical outcomes such as diagnosis of cerebral oedema.Results:96 patients with DKA were admitted to eight PCCUs between January 2013 and December 2017. The median age at presentation was 9 years and weight was 32.4kg. Of all admissions, 25% were invasively ventilated, 4% received vasoactive support, 10% received renal replacement therapy and 98% survived to discharge. 42% were suspected to have cerebral oedema with older children being more likely to be diagnosed with cerebral oedema. There was no significant difference in receiving renal replacement therapy, mechanical ventilation, vasoactive support or a clinical diagnosis of cerebral oedema between the two treatment protocols.Conclusion:Compliance was lower for the guideline with a more restrictive fluid protocol. The study found no evidence to suggest that differing fluid management across BSPED guidance had any significant impact on clinical outcomes. A larger prospective study is needed to study the impact of the revised 2020 guidance.