Effects of insulin infusion volume on diabetic ketoacidosis outcome in pediatrics: Retrospective observational study

Diabetic ketoacidosis (DKA) poses a significant risk to diabetic pediatric patients, warranting effective management strategies to prevent complications. Current DKA management protocols often use normal saline for insulin infusion, which can contribute to hyperchloremia. This study aimed to compare the effects of 2 insulin concentrations (1 unit of regular human insulin per 1 mL vs 1 unit per 10 mL of 0.9% sodium chloride) on the incidence of hyperchloremic metabolic acidosis (HMA). A retrospective observational study was conducted on pediatric patients admitted to a large pediatric hospital, recognized as a leading provider of tertiary pediatric care in the region, from January 2018 to June 2023. The study compared preprotocol (1 unit/10 mL) and postprotocol (1 unit/1 mL) insulin concentrations. Data collected included demographics, DKA severity, electrolytes, intravenous fluid type, total volume, chloride load, and length of hospital stay. The study included 279 DKA admissions, with 140 preprotocol and 139 postprotocol cases. The postprotocol group had a higher incidence of new onset of type 1 diabetes cases. The incidence of HMA was 38% (53 patients) in the postprotocol group, compared with 43% (60 patients) in the preprotocol group, but this difference was not statistically significant (P = .365). Furthermore, the total chloride load per kg in the first 24 hours showed no statistical significance between the pre- and postgroups (mean 11 ± 5 and 11 ± 5, respectively; P = .665). Similarly, length of stay also showed no significant difference between the pre- and postprotocol groups (mean 3 ± 2 vs 4 ± 3, respectively; P = .102). This study examines the comparative effectiveness of 2 insulin concentrations in DKA treatment. Changing insulin concentrations did not influence the incidence of HMA.