1278-PUB: Acid-Base Alterations after Isotonic Fluid Resuscitation of Patients in Suspected DKA in the Pediatric Emergency Department

Abstract

Introduction: Pediatric patients presenting to the emergency department (ED) for diabetic ketoacidosis (DKA) often present with dehydration, with admission to the intensive care unit (ICU) dependent on measures of dehydration and acidosis. Objective: The objective of this study was to assess the effect of fluid resuscitation in the ED on patient disposition to the ICU or floor based on changes in markers of dehydration and acidosis. Methods: This investigation was a single-center, retrospective study of patients 6 to 18 years old presenting to the ED for concern of DKA from 2016-2019. Patients with pre-bolus and post-bolus venous blood gas (VBG) were included. Each pre-bolus and post-bolus VBG was classified as meeting ICU or floor criteria. Based on the protocol developed at Rainbow Babies and Children’s Hospital, ICU criteria were pH < 7.3 and/or bicarbonate (HCO3) < 15 (on VBG or renal function panel). Dehydration was assessed using heart rate and blood urea nitrogen (BUN), adjusted by age. Continuous variables were analyzed using Kruskal-Wallis test, and categorical variables were analyzed with the chi-square test or Fisher’s exact test. Results: In this study, 187 patients met inclusion criteria. Post-bolus pH was increased in 52%, decreased in 41%, and unchanged in 7%. Post-bolus bicarbonate was increased in 44%, decreased in 53%, and unchanged in 2%. Of 145 patients with initial disposition to the ICU, 26 (17.9%) met floor criteria post-bolus, and no marker for dehydration distinguished this cohort (p=0.054 for heart rate, p=0.93 for BUN). Of 40 patients with initial disposition to the floor, 7 (17.5%) met ICU criteria post-bolus, and no marker for dehydration distinguished this cohort (p=0.68 for heart rate and p=1 for BUN). Conclusion: Patients presenting to the ED in DKA may have a decrease in pH or HCO3 following a normal saline bolus. In patients initially meeting criteria for the floor, up to 17.5% may change disposition to the ICU after a normal saline bolus. Disclosure S. Gera: None. S. P. Sheth: None. K. A. Kutney: None. S. Malay: None.