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

Pediatric Emergency Care Applied Research Network (PECARN) FLUID Study Group

doi:10.1016/j.annemergmed.2023.01.001

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

Pediatric Emergency Care Applied Research Network (PECARN) FLUID Study Group

Pediatrics

Research output: Contribution to journal › Article › peer-review

7 Scopus citations

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.

Original language	English (US)
Pages (from-to)	167-178
Number of pages	12
Journal	Annals of Emergency Medicine
Volume	82
Issue number	2
DOIs	https://doi.org/10.1016/j.annemergmed.2023.01.001
State	Published - Aug 2023

Funding

Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org ). Dr. Kuppermann reported receiving personal fees from InsuCalc outside the submitted work. The rest of the authors do not have any conflict of interest to declare. This study was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health (grant No. U01HD062417 ) and Emergency Medical Services for Children Network Development Demonstration Program of the Maternal and Child Health Bureau , Health Resources and Services Administration , under a cooperative agreement (awards U03MC00008, U03MC00001, U03MC00003, U03MC00006, U03MC00007, U03MC22684, and U03MC22685).

ASJC Scopus subject areas

Emergency Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.annemergmed.2023.01.001

Cite this

@article{f69d6fae3a1d47e8b0883a748804c712,

title = "Clinical and Laboratory Predictors of Dehydration Severity in Children With Diabetic Ketoacidosis",

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.",

author = "{Pediatric Emergency Care Applied Research Network (PECARN) FLUID Study Group} and Trainor, {Jennifer L.} and Glaser, {Nicole S.} and Leah Tzimenatos and Stoner, {Michael J.} and Brown, {Kathleen M.} and McManemy, {Julie K.} and Schunk, {Jeffrey E.} and Quayle, {Kimberly S.} and Nigrovic, {Lise E.} and Arleta Rewers and Myers, {Sage R.} and Bennett, {Jonathan E.} and Kwok, {Maria Y.} and Olsen, {Cody S.} and Casper, {T. Charles} and Simona Ghetti and Nathan Kuppermann and Perry, {Clinton S.} and Marcin, {James P.} and Mary Murray and Jared Henricksen and Brad Poss and Dean, {J. Michael} and Bema Bonsu and Tensing Maa and Justin Indyk and Marian Rewers and Peter Mourani and Kushner, {Jake A.} and Loftis, {Laura L.} and Monika Goyal and Rakesh Mistry and Vijay Srinivasan and Andrew Palladino and Colin Hawkes and Wolfsdorf, {Joseph I.} and Agus, {Michael S.} and Linda Snelling and Charlotte Boney and Cogen, {Fran R.} and Sonali Basu and White, {Neil H.} and Kolovos, {Nikoleta S.} and Donald Zimmerman and Denise Goodman and DePiero, {Andrew D.} and Doyle, {Daniel A.} and Frizzola, {Meg A.} and Scott Baird and David Schnadower",

note = "Publisher Copyright: {\textcopyright} 2023 American College of Emergency Physicians",

year = "2023",

month = aug,

doi = "10.1016/j.annemergmed.2023.01.001",

language = "English (US)",

volume = "82",

pages = "167--178",

journal = "Annals of Emergency Medicine",

issn = "0196-0644",

publisher = "Elsevier Inc.",

number = "2",

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TY - JOUR

T1 - Clinical and Laboratory Predictors of Dehydration Severity in Children With Diabetic Ketoacidosis

AU - Pediatric Emergency Care Applied Research Network (PECARN) FLUID Study Group

AU - Trainor, Jennifer L.

AU - Glaser, Nicole S.

AU - Tzimenatos, Leah

AU - Stoner, Michael J.

AU - Brown, Kathleen M.

AU - McManemy, Julie K.

AU - Schunk, Jeffrey E.

AU - Quayle, Kimberly S.

AU - Nigrovic, Lise E.

AU - Rewers, Arleta

AU - Myers, Sage R.

AU - Bennett, Jonathan E.

AU - Kwok, Maria Y.

AU - Olsen, Cody S.

AU - Casper, T. Charles

AU - Ghetti, Simona

AU - Kuppermann, Nathan

AU - Perry, Clinton S.

AU - Marcin, James P.

AU - Murray, Mary

AU - Henricksen, Jared

AU - Poss, Brad

AU - Dean, J. Michael

AU - Bonsu, Bema

AU - Maa, Tensing

AU - Indyk, Justin

AU - Rewers, Marian

AU - Mourani, Peter

AU - Kushner, Jake A.

AU - Loftis, Laura L.

AU - Goyal, Monika

AU - Mistry, Rakesh

AU - Srinivasan, Vijay

AU - Palladino, Andrew

AU - Hawkes, Colin

AU - Wolfsdorf, Joseph I.

AU - Agus, Michael S.

AU - Snelling, Linda

AU - Boney, Charlotte

AU - Cogen, Fran R.

AU - Basu, Sonali

AU - White, Neil H.

AU - Kolovos, Nikoleta S.

AU - Zimmerman, Donald

AU - Goodman, Denise

AU - DePiero, Andrew D.

AU - Doyle, Daniel A.

AU - Frizzola, Meg A.

AU - Baird, Scott

AU - Schnadower, David

PY - 2023/8

Y1 - 2023/8

N2 - 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.

AB - 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.

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UR - http://www.scopus.com/inward/citedby.url?scp=85151621562&partnerID=8YFLogxK

U2 - 10.1016/j.annemergmed.2023.01.001

DO - 10.1016/j.annemergmed.2023.01.001

M3 - Article

C2 - 37024382

AN - SCOPUS:85151621562

SN - 0196-0644

VL - 82

SP - 167

EP - 178

JO - Annals of Emergency Medicine

JF - Annals of Emergency Medicine

IS - 2

ER -

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

Abstract

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UN SDGs

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