Andrew DePiero1, Nathan Kuppermann2, Kathleen M Brown3, Jeff E Schunk4, Julie K McManemy5, Arleta Rewers6, Michael J Stoner7, Leah Tzimenatos8, Aris Garro9, Sage R Myers10, Kimberly S Quayle11, Jennifer L Trainor12, Maria Y Kwok13, Lise E Nigrovic14, Cody S Olsen4, T Charles Casper4, Simona Ghetti15, Nicole S Glaser16. 1. Division of Emergency Medicine, Department of Pediatrics, Nemours/A.I. DuPont Hospital for Children, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA. 2. Department of Emergency Medicine, University of California Davis Health, University of California Davis, School of Medicine, Sacramento, CA; Department of Pediatrics, University of California Davis Health, University of California Davis, School of Medicine, Sacramento, CA. 3. Division of Emergency Medicine, Department of Pediatrics, Children's National Medical Center, The George Washington School of Medicine and Health Sciences, Washington, DC. 4. Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT. 5. Division of Emergency Medicine, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX. 6. Division of Emergency Medicine, Department of Pediatrics, The Colorado Children's Hospital, University of Colorado-Denver School of Medicine, Denver, CO. 7. Division of Emergency Medicine, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University School of Medicine, Columbus, OH. 8. Department of Emergency Medicine, University of California Davis Health, University of California Davis, School of Medicine, Sacramento, CA. 9. Departments of Emergency Medicine and Pediatrics, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI. 10. Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. 11. Division of Emergency Medicine, Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine in St. Louis, St. Louis, MO. 12. Division of Emergency Medicine, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL. 13. Division of Emergency Medicine, Department of Pediatrics, New York Presbyterian Morgan Stanley Children's Hospital, Columbia University College of Physicians and Surgeons, New York, NY. 14. Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA. 15. Department of Psychology, University of California Davis, Sacramento, CA. 16. Department of Pediatrics, University of California Davis Health, University of California Davis, School of Medicine, Sacramento, CA. Electronic address: nsglaser@ucdavis.edu.
Abstract
OBJECTIVES: To characterize hemodynamic alterations occurring during diabetic ketoacidosis (DKA) in a large cohort of children and to identify clinical and biochemical factors associated with hypertension. STUDY DESIGN: This was a planned secondary analysis of data from the Pediatric Emergency Care Applied Research Network Fluid Therapies Under Investigation in DKA Study, a randomized clinical trial of fluid resuscitation protocols for children in DKA. Hemodynamic data (heart rate, blood pressure) from children with DKA were assessed in comparison with normal values for age and sex. Multivariable statistical modeling was used to explore clinical and laboratory predictors of hypertension. RESULTS: Among 1258 DKA episodes, hypertension was documented at presentation in 154 (12.2%) and developed during DKA treatment in an additional 196 (15.6%), resulting in a total of 350 DKA episodes (27.8%) in which hypertension occurred at some time. Factors associated with hypertension at presentation included more severe acidosis, (lower pH and lower pCO2), and stage 2 or 3 acute kidney injury. More severe acidosis and lower Glasgow Coma Scale scores were associated with hypertension occurring at any time during DKA treatment. CONCLUSIONS: Despite dehydration, hypertension occurs in a substantial number of children with DKA. Factors associated with hypertension include greater severity of acidosis, lower pCO2, and lower Glasgow Coma Scale scores during DKA treatment, suggesting that hypertension might be centrally mediated.
RCT Entities:
OBJECTIVES: To characterize hemodynamic alterations occurring during diabetic ketoacidosis (DKA) in a large cohort of children and to identify clinical and biochemical factors associated with hypertension. STUDY DESIGN: This was a planned secondary analysis of data from the Pediatric Emergency Care Applied Research Network Fluid Therapies Under Investigation in DKA Study, a randomized clinical trial of fluid resuscitation protocols for children in DKA. Hemodynamic data (heart rate, blood pressure) from children with DKA were assessed in comparison with normal values for age and sex. Multivariable statistical modeling was used to explore clinical and laboratory predictors of hypertension. RESULTS: Among 1258 DKA episodes, hypertension was documented at presentation in 154 (12.2%) and developed during DKA treatment in an additional 196 (15.6%), resulting in a total of 350 DKA episodes (27.8%) in which hypertension occurred at some time. Factors associated with hypertension at presentation included more severe acidosis, (lower pH and lower pCO2), and stage 2 or 3 acute kidney injury. More severe acidosis and lower Glasgow Coma Scale scores were associated with hypertension occurring at any time during DKA treatment. CONCLUSIONS: Despite dehydration, hypertension occurs in a substantial number of children with DKA. Factors associated with hypertension include greater severity of acidosis, lower pCO2, and lower Glasgow Coma Scale scores during DKA treatment, suggesting that hypertension might be centrally mediated.
Authors: D L Davies; D G Beevers; J D Briggs; A M Medina; J I Robertson; M A Schalekamp; J J Brown; A F Lever; J J Morton; M Tree Journal: Lancet Date: 1973-03-31 Impact factor: 79.321
Authors: N Glaser; P Barnett; I McCaslin; D Nelson; J Trainor; J Louie; F Kaufman; K Quayle; M Roback; R Malley; N Kuppermann Journal: N Engl J Med Date: 2001-01-25 Impact factor: 91.245
Authors: Nicole S Glaser; Sandra L Wootton-Gorges; James P Marcin; Michael H Buonocore; Joseph Dicarlo; E Kirk Neely; Patrick Barnes; Jenny Bottomly; Nathan Kuppermann Journal: J Pediatr Date: 2004-08 Impact factor: 4.406
Authors: Sage R Myers; Nicole S Glaser; Jennifer L Trainor; Lise E Nigrovic; Aris Garro; Leah Tzimenatos; Kimberly S Quayle; Maria Y Kwok; Arleta Rewers; Michael J Stoner; Jeff E Schunk; Julie K McManemy; Kathleen M Brown; Andrew D DePiero; Cody S Olsen; T Charles Casper; Simona Ghetti; Nathan Kuppermann Journal: JAMA Netw Open Date: 2020-12-01