MON-225 Potassium Chloride vs Potassium Acetate for Potassium Replacement in Pediatric Diabetic Ketoacidosis

Abstract Disclosure: M.K. Douthit: None. B.C. Patterson: None. K. Cossen: None. Introduction: Fluid resuscitation and electrolyte replacement is a mainstay in treatment of diabetic ketoacidosis (DKA). The optimal intravenous fluid (IVF) content for treatment of pediatric DKA is not established. This study compares potassium replacement with potassium chloride (KCl) vs potassium acetate (Kacetate) combined with potassium phosphate (Kphos) on DKA outcomes in pediatric patients. Methods: All pediatric DKA admissions from May-July 2023 treated with a DKA treatment protocol using normal saline (NS) with KCl and Kphos and all pediatric DKA admissions from May-July 2024 treated with a protocol using NS with Kacetate and Kphos were included in this single institution, IRB exempt, retrospective analysis. Institutional protocol change prompted the difference in treatment between the two groups. Patients who presented to an outside medical facility or received DKA treatment outside of our institution’s DKA treatment protocols were excluded from the study. Clinical and demographic data were collected via systemic chart review. We aimed to compare treatment with KCl vs Kacetate containing IVF on various DKA outcomes including duration of IV insulin, PICU length of stay (LOS), hospital LOS, and incidence of cerebral edema. Results: There were 73 patients who received KCl containing IVF and 71 patients who received Kacetate containing IVF. Fewer new onset diabetics were included in the KCl group than the Kacetate group (17 vs 27; p=0.048), and the anion gap prior to initiation of IV insulin was higher in the KCl group, (23.7±5.3 mEq/L vs 21.3±4.7 mEq/L, p=0.004). Otherwise, the groups were similar at baseline. There was no difference between the two treatment groups in time on IV insulin (KCl: 15.2±7.0 h vs Kacetate 17.3±9.2 h, NS), hospital LOS (KCl: 47.4±46.6 h vs Kacetate 49.5±28.4 h, NS), or PICU LOS for the 45 patients in each group requiring PICU admission (KCl: 18.3±9.3 h vs Kacetate 21.3±9.2 h, NS). Similarly, there was no difference in incidence of cerebral edema, represented by the number of patients needing hypertonic saline (HTS) (5 vs 6, NS). Lack of insurance, lower pH prior to initiation of IV insulin, T2DM, and admission to the PICU were all independent predictors of increased time on IV insulin in a multivariate analysis. Discussion: While several studies have evaluated the optimal fluid volume, rate of infusion, and sodium content of IVF replacement for DKA, the optimal potassium replacement is not well described. This study failed to indicate benefit from using Kacetate over KCl containing IVF in pediatric DKA. Given Kacetate containing fluids may be less accessible and often associated with higher costs, potassium replacement with Kacetate instead of KCl may not be preferable. However, the use of Kacetate was not associated with increased risk for requiring HTS or overall hospital LOS and is a viable alternative to KCl in case of IVF shortages. Presentation: Monday, July 14, 2025