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QUESTION 2: Do conservative rates of rehydration in children with diabetic ketoacidosis decrease the risk of cerebral oedema?
  1. Ravi Ajay Shah
  1. Correspondence to Mr. Ravi Ajay Shah, University of Cambridge School of Clinical Medicine, Cambridge CB2 2SP, UK; ras217{at}cam.ac.uk

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Clinical setting

A 5-year-old male child presented to the emergency department feeling generally unwell. On initial assessment he was tachypnoeic, tachycardic, peripherally shut down, normotensive and aGlasgow Coma Scale (GCS) of 14/15. He had been suffering with polyuria and polydipsia for 1 week, plus abdominal pain and vomiting for 2 days. He had no previous medical problems and no family history. Initial arterial blood gas demonstrated raised glucose, acidosis with low bicarbonate and capillary blood ketones. Diabetic ketoacidosis (DKA) was diagnosed, and the patient was given 10 mL/kg 0.9% saline fluid bolus and started on hourly fluids ([48 hourly routine maintenance +10% fluid deficit – fluid bolus]/48 hours of 0.9% saline with 40 mM potassium) as per the British Society for Paediatric Endocrinology and Diabetes (BSPED) guidelines. Fluid resuscitation is less aggressive in the treatment of childhood DKA compared with adulthood due to a fear of causing cerebral oedema. What is the evidence that more aggressive fluid therapy results in cerebral oedema?

Clinical question

In children with DKA (patient), do conservative rates of rehydration (intervention) decrease the risk of cerebral oedema (outcome)?

Literature search methods

PubMed search with the terms ((((((edema) OR oedema)) AND cerebral)) AND ((diabetic ketoacidosis) OR DKA)) AND fluid yielded …

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