# Early parameter to detect the resolution of pediatric diabetic ketoacidosis

## TL;DR

This study finds that anion gap is a faster indicator of resolving diabetic ketoacidosis in children compared to other parameters.

## Contribution

Identifies anion gap normalization as an earlier resolution marker for pediatric DKA treatment.

## Key findings

- Anion gap ≦12 mmol/L resolved in 12 h, faster than venous pH and bicarbonate recovery.
- Hyperchloremia incidence increased to 80% after 18 h of treatment.
- Most patients reached AG resolution before pH and bicarbonate normalization.

## Abstract

The present study aimed to analyze the incidence of hyperchloremia and compare the time to reach DKA resolution with different parameters.

A 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.

Overall, 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.

Hyperchloremic 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.