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- W3139457325 abstract "The 2020 British Society for Paediatric Endocrinology and Diabetes (BSPED) guideline differs from the previous iteration and the more conservative National Institute of Health and Care Excellence 2016 guideline for diabetic ketoacidosis in children and young people (2015). It recommends a more liberal approach to initial fluid resuscitation and a reduced enthusiasm for using inotropes. This contrasts with shock resuscitation guidance elsewhere. In septic shock acute fluid resuscitation is now recommended to be more selective and conservative, and the early use of vasoactive drugs is supported.1 So why did BSPED make a new recommendation for diabetic ketoacidosis (DKA)? Recent correspondence2 suggests that it arose from: (A) expert interpretation of physiological data suggesting hypoperfusion as the precursor to cerebral oedema; (B) the Pediatric Emergency Care Applied Research Network (PECARN) fluid in DKA randomised controlled trial3 and (C) regional audit data. Such evidence is not compelling.Physiological and imaging data suggest cerebral hypoperfusion may not be present at baseline. In 1948, Kety et al 4 measured cerebral blood flow (CBF) in adults with DKA: none had CBF below the normal range and several were hyperaemic. Glaser et al 5 interpreted MRI scans of patients in DKA as suggesting increased CBF. Some of this excess may have resulted from treatment. If concern about hypoperfusion is key, it is not clear why increasing perfusion with inotropes …" @default.
- W3139457325 created "2021-03-29" @default.
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- W3139457325 date "2021-03-19" @default.
- W3139457325 modified "2023-09-27" @default.
- W3139457325 title "Fluid resuscitation in diabetic ketoacidosis and the BPSED guidelines: what we still don’t know" @default.
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- W3139457325 doi "https://doi.org/10.1136/archdischild-2020-320078" @default.
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