Why the study?
Does low-dose continuous intravenous insulin reduce hypoglycemia and hypokalemia compared to high-dose insulin while maintaining efficacy in children with diabetic ketoacidosis?
Does low-dose continuous intravenous insulin reduce hypoglycemia and hypokalemia compared to high-dose insulin while maintaining efficacy in children with diabetic ketoacidosis?
Low-dose continuous intravenous insulin (0.1 U/kg/h) is as effective as high-dose insulin for treating pediatric DKA, while significantly reducing the risk of hypokalemia and hypoglycemia.
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Supports low-dose insulin preference in pediatric DKA; confirms RCT safety advantage with preserved efficacy.
We studied the efficacy of low-dose (0.1 U/kg/h) and high-dose (1..0 U/kg/h) insulin, given randomly to children with diabetic ketoacidosis (DKA) by continuous intravenous infusion without a loading dose. Plasma glucose reached 250 mg/dl in 3.4 +/- 0.4 h with the high-dose insulin group compared with 5.4 +/- 0.5 h with the low-dose insulin group (P < 0.01). During the first 12 h of therapy, plasma glucose fell below 100 mg/dl in 2 of 16 in the low-dose compared with 12 of 16 in the high-dose patients. The decrement of ketone bodies, cortisol, and glucagon was similar in both groups. The number of hours required for HCO3(-) greater than or equal to meq/l and arterial blood pH greater than or equal to 7.30 were not significantly different in the two groups. Hypokalemia (K < 3.4 meq/L) occurred in 3 of 16 low-dose and 10 of 16 high-dose patients. The data show that low-dose insulin, with a slower rate of glucose decrease, is as effective as a high dose for the treatment of DKA in children with less incidence of hypokalemia and decreased potential for hypoglycemia.
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Burghen et al. (1980) studied this question.
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