Comparison of high-dose and low-dose insulin by continuous intravenous infusion in the treatment of diabetic ketoacidosis in children.

Abstract

We studied the efficacy of low-dose (0.1 U/kg/h) and high-dose (1..0 U/kg/h) insulin, given randomly to children with diabetic ketoacidosis (DKA) by continuous intravenous infusion without a loading dose. Plasma glucose reached 250 mg/dl in 3.4 +/- 0.4 h with the high-dose insulin group compared with 5.4 +/- 0.5 h with the low-dose insulin group (P < 0.01). During the first 12 h of therapy, plasma glucose fell below 100 mg/dl in 2 of 16 in the low-dose compared with 12 of 16 in the high-dose patients. The decrement of ketone bodies, cortisol, and glucagon was similar in both groups. The number of hours required for HCO3(-) greater than or equal to meq/l and arterial blood pH greater than or equal to 7.30 were not significantly different in the two groups. Hypokalemia (K < 3.4 meq/L) occurred in 3 of 16 low-dose and 10 of 16 high-dose patients. The data show that low-dose insulin, with a slower rate of glucose decrease, is as effective as a high dose for the treatment of DKA in children with less incidence of hypokalemia and decreased potential for hypoglycemia.

• Authors: G A Burghen, J N Etteldorf, J N Fisher, A Q Kitabchi
• Journal: Diabetes care (Diabetes Care) 1980 Jan-Feb Vol. 3 Issue 1 Pg. 15-20 ISSN: 0149-5992 [Print] United States
• PMID: 6773725 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Blood Glucose
• Insulin
• Ketone Bodies
• Glucagon
• Hydrocortisone

Topics

• Adolescent
• Blood Glucose (metabolism)
• Child
• Diabetic Ketoacidosis (blood, drug therapy)
• Glucagon (blood)
• Humans
• Hydrocortisone (blood)
• Hydrogen-Ion Concentration
• Infusions, Parenteral (instrumentation)
• Insulin (administration & dosage)
• Ketone Bodies (blood)
• Prospective Studies