Early parameter to detect the resolution of pediatric diabetic ketoacidosis
ObjectiveThe present study aimed to analyze the incidence of hyperchloremia and compare the time to reach DKA resolution with different parameters.MethodsA chart review of patients diagnosed with DKA and aged <18 years was conducted. DKA was defined as serum glucose ≧200 mg/dl, venous pH (vpH...
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Frontiers Media S.A.
2025-04-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2025.1570859/full |
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| author | Yi-Hsuan Liu Yi-Hsuan Liu Ya-Ting Su Ya-Ting Su Jainn-Jim Lin Jainn-Jim Lin Oi-Wa Chan Oi-Wa Chan Chen-Wei Yen Chen-Wei Yen En-Pei Lee En-Pei Lee |
| author_facet | Yi-Hsuan Liu Yi-Hsuan Liu Ya-Ting Su Ya-Ting Su Jainn-Jim Lin Jainn-Jim Lin Oi-Wa Chan Oi-Wa Chan Chen-Wei Yen Chen-Wei Yen En-Pei Lee En-Pei Lee |
| author_sort | Yi-Hsuan Liu |
| collection | DOAJ |
| description | ObjectiveThe present study aimed to analyze the incidence of hyperchloremia and compare the time to reach DKA resolution with different parameters.MethodsA chart review of patients diagnosed with DKA and aged <18 years was conducted. DKA was defined as serum glucose ≧200 mg/dl, venous pH (vpH) <7.30, serum bicarbonate <15 mmol/L, and presence of ketonemia, or ketonuria. Electrolytes and blood gases were recorded at 6-h intervals after treatment initiation.ResultsOverall, 84 patients were admitted because of DKA. The initial biomedical parameters in the emergency department were as follows: median glucose, 497 mg/dl; vpH, 7.1; serum HCO3, 6.6 mmol/L; anion gap (AG), 24.7 mmol/L; and ketone, 5.7 mmol/L. After treatment, the incidence of hyperchloremia increased progressively from 15.4% at treatment initiation to 80% at 18 h. The median time to resolution defined by AG ≦12 mmol/L was 12 h, which was significantly faster than the recovery of vpH ≧7.3 (median time, 17 h) and HCO3 >15 mmol/L (median time, 18 h). Approximately 63 (75%) patients reached the endpoints of AG ≦12 mmol/L prior, 14 (16.6%) patients reached the endpoints of vpH ≧7.3 prior, 7 (8.4%) patients reached the endpoints of HCO3 >15 mmol/L prior.ConclusionsHyperchloremic metabolic acidosis (HMA) was a common entity in pediatric DKA following treatment. The median time of AG ≦ 12 mmol/L was approximately 12 h and was the parameter that can identify DKA resolution at a faster rate, i.e., approximately 5, and 6 h faster than the normalization of vpH and HCO3, respectively. Future studies were warranted to use AG ≦12 mmol/L as the endpoint of DKA treatment and check if the treatment course and incidence of HMA could be reduced. |
| format | Article |
| id | doaj-art-6b94ecca9e6c4ee08afb2f31b4c4f6d6 |
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| language | English |
| publishDate | 2025-04-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Pediatrics |
| spelling | doaj-art-6b94ecca9e6c4ee08afb2f31b4c4f6d62025-08-20T02:09:14ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602025-04-011310.3389/fped.2025.15708591570859Early parameter to detect the resolution of pediatric diabetic ketoacidosisYi-Hsuan Liu0Yi-Hsuan Liu1Ya-Ting Su2Ya-Ting Su3Jainn-Jim Lin4Jainn-Jim Lin5Oi-Wa Chan6Oi-Wa Chan7Chen-Wei Yen8Chen-Wei Yen9En-Pei Lee10En-Pei Lee11College of Medicine, Chang Gung University, Taoyuan, TaiwanDivision of Pediatric Neurology, Chang Gung Children’s Hospital and Chang Gung Memorial Hospital, Taoyuan, TaiwanCollege of Medicine, Chang Gung University, Taoyuan, TaiwanDivision of Pediatric Endocrinology and Genetics, Department of Pediatrics, Chang Gung Memorial Hospital, Taipei, TaiwanCollege of Medicine, Chang Gung University, Taoyuan, TaiwanDivision of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Taoyuan, TaiwanCollege of Medicine, Chang Gung University, Taoyuan, TaiwanDivision of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Taoyuan, TaiwanCollege of Medicine, Chang Gung University, Taoyuan, TaiwanDivision of Nephrology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, TaiwanCollege of Medicine, Chang Gung University, Taoyuan, TaiwanDivision of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Taoyuan, TaiwanObjectiveThe present study aimed to analyze the incidence of hyperchloremia and compare the time to reach DKA resolution with different parameters.MethodsA chart review of patients diagnosed with DKA and aged <18 years was conducted. DKA was defined as serum glucose ≧200 mg/dl, venous pH (vpH) <7.30, serum bicarbonate <15 mmol/L, and presence of ketonemia, or ketonuria. Electrolytes and blood gases were recorded at 6-h intervals after treatment initiation.ResultsOverall, 84 patients were admitted because of DKA. The initial biomedical parameters in the emergency department were as follows: median glucose, 497 mg/dl; vpH, 7.1; serum HCO3, 6.6 mmol/L; anion gap (AG), 24.7 mmol/L; and ketone, 5.7 mmol/L. After treatment, the incidence of hyperchloremia increased progressively from 15.4% at treatment initiation to 80% at 18 h. The median time to resolution defined by AG ≦12 mmol/L was 12 h, which was significantly faster than the recovery of vpH ≧7.3 (median time, 17 h) and HCO3 >15 mmol/L (median time, 18 h). Approximately 63 (75%) patients reached the endpoints of AG ≦12 mmol/L prior, 14 (16.6%) patients reached the endpoints of vpH ≧7.3 prior, 7 (8.4%) patients reached the endpoints of HCO3 >15 mmol/L prior.ConclusionsHyperchloremic metabolic acidosis (HMA) was a common entity in pediatric DKA following treatment. The median time of AG ≦ 12 mmol/L was approximately 12 h and was the parameter that can identify DKA resolution at a faster rate, i.e., approximately 5, and 6 h faster than the normalization of vpH and HCO3, respectively. Future studies were warranted to use AG ≦12 mmol/L as the endpoint of DKA treatment and check if the treatment course and incidence of HMA could be reduced.https://www.frontiersin.org/articles/10.3389/fped.2025.1570859/fulldiabetic ketoacidosischildrenhyperchloremiaresolutionanion gap |
| spellingShingle | Yi-Hsuan Liu Yi-Hsuan Liu Ya-Ting Su Ya-Ting Su Jainn-Jim Lin Jainn-Jim Lin Oi-Wa Chan Oi-Wa Chan Chen-Wei Yen Chen-Wei Yen En-Pei Lee En-Pei Lee Early parameter to detect the resolution of pediatric diabetic ketoacidosis Frontiers in Pediatrics diabetic ketoacidosis children hyperchloremia resolution anion gap |
| title | Early parameter to detect the resolution of pediatric diabetic ketoacidosis |
| title_full | Early parameter to detect the resolution of pediatric diabetic ketoacidosis |
| title_fullStr | Early parameter to detect the resolution of pediatric diabetic ketoacidosis |
| title_full_unstemmed | Early parameter to detect the resolution of pediatric diabetic ketoacidosis |
| title_short | Early parameter to detect the resolution of pediatric diabetic ketoacidosis |
| title_sort | early parameter to detect the resolution of pediatric diabetic ketoacidosis |
| topic | diabetic ketoacidosis children hyperchloremia resolution anion gap |
| url | https://www.frontiersin.org/articles/10.3389/fped.2025.1570859/full |
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