Fluid Therapy For Pediatric Patients With Diabetic Ketoacidosis: Current Perspectives

Muralidharan Jayashree, Vijai Williams, Rajalakshmi Iyer Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, IndiaCorrespondence: Muralidharan JayashreeDivision of Pediatric E...

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Autores principales:	Jayashree M, Williams V, Iyer R
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2019
Materias:	fluids diabetes ketoacidosis pediatrics children Specialties of internal medicine RC581-951
Acceso en línea:	https://doaj.org/article/0176d57a65e94a03a84d0e123e293869
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spelling	oai:doaj.org-article:0176d57a65e94a03a84d0e123e2938692021-12-02T03:55:58ZFluid Therapy For Pediatric Patients With Diabetic Ketoacidosis: Current Perspectives1178-7007https://doaj.org/article/0176d57a65e94a03a84d0e123e2938692019-11-01T00:00:00Zhttps://www.dovepress.com/fluid-therapy-for-pediatric-patients-with-diabetic-ketoacidosis-curren-peer-reviewed-article-DMSOhttps://doaj.org/toc/1178-7007Muralidharan Jayashree, Vijai Williams, Rajalakshmi Iyer Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, IndiaCorrespondence: Muralidharan JayashreeDivision of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, IndiaTel +91 172 275 5311Fax +91-172-2744401Email mjshree@hotmail.comAbstract: Diabetic ketoacidosis (DKA) is a preventable life-threatening complication of type 1 diabetes. Fluids form a crucial component of DKA therapy, goals being the restoration of intravascular, interstitial and intracellular compartments. Hydration reduces hyperglycemia by decreased counter-regulatory hormones, enhanced renal glucose clearance and augmented insulin sensitivity. However, for the last several decades, fluids in DKA have been subject of intense debate owing to their possible role in causation of cerebral edema (CE). Rehydration protocols have been modified to prevent major osmotic shifts, correct electrolyte imbalances and avoid cerebral or pulmonary edema. In DKA, a conservative deficit assumption ranging from 6.5% to 8.5% is preferred. Normal saline (0.9%) has been the traditional fluid of choice, for both, volume resuscitation and deficit replacement in DKA. However, the risk of AKI with its liberal chloride content remains a contentious issue. On the other hand, balanced crystalloids with restricted chloride content need more exploration in children with DKA, both with respect to DKA resolution and AKI. Although fluids are an integral part of DKA management, a fine balance is needed to avoid under-hydration or over-hydration during DKA management. In this narrative review, we discuss the current perspectives on fluids in pediatric DKA.Keywords: fluids, diabetes, ketoacidosis, pediatrics, childrenJayashree MWilliams VIyer RDove Medical PressarticlefluidsdiabetesketoacidosispediatricschildrenSpecialties of internal medicineRC581-951ENDiabetes, Metabolic Syndrome and Obesity: Targets and Therapy, Vol Volume 12, Pp 2355-2361 (2019)
institution	DOAJ
collection	DOAJ
language	EN
topic	fluids diabetes ketoacidosis pediatrics children Specialties of internal medicine RC581-951
spellingShingle	fluids diabetes ketoacidosis pediatrics children Specialties of internal medicine RC581-951 Jayashree M Williams V Iyer R Fluid Therapy For Pediatric Patients With Diabetic Ketoacidosis: Current Perspectives
description	Muralidharan Jayashree, Vijai Williams, Rajalakshmi Iyer Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, IndiaCorrespondence: Muralidharan JayashreeDivision of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, IndiaTel +91 172 275 5311Fax +91-172-2744401Email mjshree@hotmail.comAbstract: Diabetic ketoacidosis (DKA) is a preventable life-threatening complication of type 1 diabetes. Fluids form a crucial component of DKA therapy, goals being the restoration of intravascular, interstitial and intracellular compartments. Hydration reduces hyperglycemia by decreased counter-regulatory hormones, enhanced renal glucose clearance and augmented insulin sensitivity. However, for the last several decades, fluids in DKA have been subject of intense debate owing to their possible role in causation of cerebral edema (CE). Rehydration protocols have been modified to prevent major osmotic shifts, correct electrolyte imbalances and avoid cerebral or pulmonary edema. In DKA, a conservative deficit assumption ranging from 6.5% to 8.5% is preferred. Normal saline (0.9%) has been the traditional fluid of choice, for both, volume resuscitation and deficit replacement in DKA. However, the risk of AKI with its liberal chloride content remains a contentious issue. On the other hand, balanced crystalloids with restricted chloride content need more exploration in children with DKA, both with respect to DKA resolution and AKI. Although fluids are an integral part of DKA management, a fine balance is needed to avoid under-hydration or over-hydration during DKA management. In this narrative review, we discuss the current perspectives on fluids in pediatric DKA.Keywords: fluids, diabetes, ketoacidosis, pediatrics, children
format	article
author	Jayashree M Williams V Iyer R
author_facet	Jayashree M Williams V Iyer R
author_sort	Jayashree M
title	Fluid Therapy For Pediatric Patients With Diabetic Ketoacidosis: Current Perspectives
title_short	Fluid Therapy For Pediatric Patients With Diabetic Ketoacidosis: Current Perspectives
title_full	Fluid Therapy For Pediatric Patients With Diabetic Ketoacidosis: Current Perspectives
title_fullStr	Fluid Therapy For Pediatric Patients With Diabetic Ketoacidosis: Current Perspectives
title_full_unstemmed	Fluid Therapy For Pediatric Patients With Diabetic Ketoacidosis: Current Perspectives
title_sort	fluid therapy for pediatric patients with diabetic ketoacidosis: current perspectives
publisher	Dove Medical Press
publishDate	2019
url	https://doaj.org/article/0176d57a65e94a03a84d0e123e293869
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Fluid Therapy For Pediatric Patients With Diabetic Ketoacidosis: Current Perspectives

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