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Fluid management in diabetic ketoacidosis
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  • Published on:
    A DKA Summit?

    Dear Editor

    I thank Dr Edge and other correspondents and am gratified that none dissents from the view of Dr Inward and myself that the assessment and fluid management of DKA in childhood needs multispecialty review. Perhaps this is underway: if not then should our College President - Elect invite his Newcastle colleague Sir George Alberti to convene and chair it?

    TL Chambers

    Conflict of Interest:
    None declared.
  • Published on:
    Ketoacid levels may alter osmotonicity in diabetic ketoacidosis and precipitate cerebral edema
    • Jacob M Puliyel, Consultant Pediatrician
    • Other Contributors:
      • Vikas Bhambhani

    Dear Editor

    Cerebral Edema During Treatment of Diabetic Ketoacidosis: Fall In Ketoacid Levels and Consequent Fall In Osmolality May Be A Culprit

    Inward and Chambers[1] have called for a rethink of the management of diabetic ketoacidosis. In their article they quote a study by Grove L M and colleagues[2] suggesting that pediatricians overestimated the quantum of dehydration in DKA. Over correction of dehydrat...

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    Conflict of Interest:
    None declared.
  • Published on:
    Re: Fluid management in diabetic ketoacidosis

    Dear Editor

    I read with interest "Fluid Management in Diabetic Ketoacidosis" published in June 2002.[1] I appreciate that duration of fluid therapy for correction of dehydration is of profound importance. I also feel that the issue of giving potassium in form of potassium phosphate is inadequately addressed in most of the guidelines for management of DKA in this country.

    It is almost inevitable that...

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    Conflict of Interest:
    None declared.
  • Published on:
    Physiologic management of DKA
    • Glenn D Harris, Physician - Associate Professor of Pediatrics
    • Other Contributors:
      • Irma Fiordalisi, MD

    Dear Editor

    Inward and Chambers provide a provocative description and discussion of the continued confusion regarding the issues surrounding rehydration and treatment of the pediatric patient with DKA.[1] They review some of the key issues that link fluid therapy to complications from brain swelling, and question the appropriateness of using a volume of fluid calculated by 'maintenance plus deficit', calling for...

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    Conflict of Interest:
    None declared.
  • Published on:
    Fluid therapy and diabetic ketoacidosis: the intensive care perspective
    • Andrew Durward, Consultant PICU
    • Other Contributors:
      • Shane M. Tibby, Shymala Moganasundrum, and Ian A. Murdoch

    Dear Editor

    We read with interest the article by Inward and Chambers proposing a review on the current fluid management of DKA in the United Kingdom.[1] The authors correctly state the importance of avoiding “rapid rates of fluid infusion” and the need to “maintain serum sodium concentrations” in order to reduce the administration of free water and hence reduce the risk of cerebral oedema.

    It has been ou...

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    Conflict of Interest:
    None declared.