Rehydration Rates and Outcomes in Overweight Children With Diabetic Ketoacidosis

Pediatrics. 2023 Dec 1;152(6):e2023062004. doi: 10.1542/peds.2023-062004.


Background and objectives: The Pediatric Emergency Care Applied Research Network Fluid Therapies Under Investigation in Diabetic Ketoacidosis (DKA) (FLUID) Trial found that rapid fluid infusion does not increase the risk of cerebral injury. Concern persists, however, whether fluid rates should be adjusted for overweight or obese patients. We used the FLUID Trial database to evaluate associations between fluid infusion rate and outcomes in these patients.

Methods: We compared children and youth who were overweight, obese, or normal weight, in regard to protocol adherence, mental status changes, time to DKA resolution, and electrolyte abnormalities. We investigated associations between outcomes and the amount of fluid received in these groups.

Results: Obese children and youth were more likely to receive fluids at rates slower than dictated by protocol. Overweight and obese children and youth in the fast fluid arms, who received fluids per the study protocol based on their measured weight, had similar rates of mental status changes or clinically apparent cerebral injury as those with normal weights. Risk of hypophosphatemia was increased in those receiving larger initial bolus volumes and reduced in those receiving higher rehydration rates. No other metabolic outcomes were associated with rehydration.

Conclusions: Protocol adherence data in the FLUID Trial suggest that physicians are uncomfortable using weight-based fluid calculations for overweight or obese children. However, higher rates of fluid infusion were not associated with increased risk of mental status changes or cerebral injury, suggesting that physicians should not limit fluid resuscitation in obese children and youth with DKA.

MeSH terms

  • Adolescent
  • Child
  • Clinical Trials as Topic
  • Diabetes Mellitus*
  • Diabetic Ketoacidosis* / complications
  • Diabetic Ketoacidosis* / epidemiology
  • Diabetic Ketoacidosis* / therapy
  • Fluid Therapy / methods
  • Humans
  • Infusions, Intravenous
  • Overweight / complications
  • Overweight / epidemiology
  • Overweight / therapy
  • Pediatric Obesity* / complications
  • Pediatric Obesity* / epidemiology
  • Pediatric Obesity* / therapy