For decades now, aggressive fluid replacement in pediatric DKA patients has been thought to contribute to cerebral edema and neurologic injury. This has resulted in a general policy of cautious fluid replacement with isotonic crystalloid, and perhaps even contributed to under-resuscitation of these patients. In this first large, randomized, prospective study to examine the role of type of fluid (0.9% NaCl vs 0.45% NaCl) and rate of administration, the hope was to detemine if type of fluid, rate of adminstration, or both were associated with cerebral edema and neurologic injury in this patient population. Read on for the key results of this practice changing paper!
This post was inspired by a recent clinical case in our department. A 7 week full term infant s/p spontaneous vaginal delivery with a normal maternal prenatal screen and course presents to your ED for not eating x 12 hours. On exam, you note decreased spontaneous movements, a weak suck and a weak cry noted. Vitals are normal. What's the diagnosis?
You are working a Sunday shift when the outpatient labs are closed, when a newborn arrives for their bilirubin check. Checking the lab is easy enough but do you know what to do with the result?