NIH study finds no significant link between brain injury and IV fluid treatment of pediatric diabetic ketoacidosis

What

Giving children intravenous (IV) fluids to treat diabetic ketoacidosis — an emergency complication of untreated diabetes — does not appear to worsen the brain swelling that may accompany the condition, according to a study supported by the National Institutes of Health. The findings, published in the New England Journal of Medicine, contrast with widespread concern that providing too much IV fluid may result in serious brain injury.

Diabetic ketoacidosis is often the first sign of type 1 diabetes in children who have not yet been diagnosed. Deprived of glucose, the liver converts body fat into ketones, which turn the blood acidic. Untreated diabetic ketoacidosis can be fatal.

The study, funded by NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development, was conducted at 13 U.S. emergency departments that participate in the Pediatric Emergency Care Applied Research Network (PECARN). It enrolled more than 1,300 children with diabetic ketoacidosis. The research team, led by investigators at the University of California, Davis, divided the children into four treatment regimens, varying the amount and rate of IV fluid infusion — from rapid or gradual — and varying the sodium content of the fluid.

Researchers found no difference in brain injury rates among the treatment regimens. Neither the infusion rate nor the sodium content of the fluid significantly influenced neurological outcomes of the children in the study.

Who

To arrange an interview with Tammara L. Jenkins, MSN, RN, who oversees this PECARN study at NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development, please contact Meredith Daly at 301-496-5133 or email nichdpress@mail.nih.gov(link sends e-mail).

Article

Kuppermann N, et al., Clinical trial of fluid infusion rates for pediatric diabetic ketoacidosis. New England Journal of Medicine DOI:10.1056/NEJMoa1716816.

About the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): NICHD conducts and supports research in the United States and throughout the world on fetal, infant and child development; maternal, child and family health; reproductive biology and population issues; and medical rehabilitation. For more information, visit NICHD’s website.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

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