G575(P) Acute kidney injury and diabetic ketoacidosis; intravenous fluids or ph the culprit?

• Published in: Archives of disease in childhood Vol. 104; no. Suppl 2; p. A232
• Main Authors: Ho, CH, Wong, CW, Randell, TR
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01-05-2019
• Subjects: Blood; Creatinine; Diabetes; Diabetes mellitus; Diabetic ketoacidosis; Endocrinology; Fluids; Intravenous administration; Ketoacidosis; Kidneys; Patients; Pediatrics; pH effects; Statistical analysis
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2019-rcpch.556

AimsThe aim of this study is to assess the influence of intravenous (IV) fluid regimens and blood pH on the incidence of acute kidney injury (AKI) in paediatric diabetic ketoacidosis (DKA). This is in light of recent studies raising concerns around this topic, and the 2015 update of the British Society for Paediatric Endocrinology and Diabetes (BSPED) guidelines for the management of paediatric DKA, which recommended a substantial reduction in fluid volumes given during DKA treatment.MethodThe following data was collected from patients under the age of 18, who were admitted to a children’s hospital with DKA from 2010 to 2018; volume of IV fluid received during admission (ml/kg/day), blood pH on admission, and the second creatinine level following admission.The sample was then divided into those who had AKI, and those who did not. AKI was defined by a second creatinine reading 1.5 times greater than the upper limit for their respective age group and gender.Results74 patients were included in the sample, 14 of whom had AKI. The mean volume of IV fluid received in patients with AKI was 65.7 ml/kg/day, compared with 52.5 ml/kg/day in the patients without AKI. A chi-squared test was performed to explore the difference between the volume of IV fluid given (ml/kg/day) between patients with AKI and those without; a p-value of 0.078 was generated. The mean blood pH of patients who had AKI was 7.08, whereas those without AKI had a mean pH of 7.15.ConclusionThis study failed to demonstrate a statistically significant difference between the volume of IV fluid (mg/kg/day) given to patients with AKI and those without AKI. From a clinical point of view, the mean blood pH on presentation was significantly lower in those with AKI. This suggests the severity of DKA to be a more predictive indicator of AKI than the volume of IV fluid given.