{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T14:17:27Z","timestamp":1754144247442,"version":"3.41.2"},"reference-count":18,"publisher":"The Endocrine Society","issue":"8","license":[{"start":{"date-parts":[[2024,12,6]],"date-time":"2024-12-06T00:00:00Z","timestamp":1733443200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Context<\/jats:title>\n                  <jats:p>Adverse outcomes (death or intensive care unit [ICU] stays longer than 48\u2005hours) in children with diabetic ketoacidosis (DKA) or hyperglycemic\u2013hyperosmolar syndrome (HHS) can be predicted by a composite risk score based on severity of hyperglycemia and acidosis, and presence of type 2 diabetes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Because most high-risk patients nevertheless do not experience an adverse outcome, we tried to identify differences in management or other clinical characteristics that influenced outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>In a previously defined group of 4565 admissions for DKA-HHS in 2010-2023, 109 had adverse outcomes. We conducted a nested case\u2013control study using the composite risk score to match 84 cases from the adverse outcome group with an equal number of controls without or with briefer ICU stays of 0 to 24\u2005hours.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The groups did not differ in risk score or initial pH, maximum blood glucose, or proportion with type 2 diabetes. However, the case group had more patients with new-onset diabetes and higher initial serum sodium and blood urea nitrogen. The case group had slower resolution of hyperglycemia, acidosis, and hypernatremia. The groups did not differ in total administered fluid bolus volumes, total fluid volumes, or urine output at 12 and 24\u2005hours. Total insulin received did not differ between groups after 12\u2005hours, but cases were more likely to still require intravenous insulin at 24\u2005hours.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Hypernatremia is more likely to be present at admission and to persist over the first 24\u2005hours of treatment in children with DKA-HHS who have adverse outcomes. This is not associated with differences in management.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1210\/clinem\/dgae848","type":"journal-article","created":{"date-parts":[[2024,12,10]],"date-time":"2024-12-10T17:36:26Z","timestamp":1733852186000},"page":"e2517-e2522","source":"Crossref","is-referenced-by-count":0,"title":["A Nested Case\u2013Control Study of Adverse Outcomes in Children With Diabetic Ketoacidosis"],"prefix":"10.1210","volume":"110","author":[{"given":"Maha F","family":"Yousif","sequence":"first","affiliation":[{"name":"Division of Pediatric Endocrinology, Department of Pediatrics, UT Southwestern Medical Center , Dallas, TX 75390-9063 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katie D","family":"Dolak","sequence":"additional","affiliation":[{"name":"Division of Pediatric Endocrinology, Department of Pediatrics, UT Southwestern Medical Center , Dallas, TX 75390-9063 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Soumya","family":"Adhikari","sequence":"additional","affiliation":[{"name":"Division of Pediatric Endocrinology, Department of Pediatrics, UT Southwestern Medical Center , Dallas, TX 75390-9063 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6262-0289","authenticated-orcid":false,"given":"Perrin C","family":"White","sequence":"additional","affiliation":[{"name":"Division of Pediatric Endocrinology, Department of Pediatrics, UT Southwestern Medical Center , Dallas, TX 75390-9063 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"80","published-online":{"date-parts":[[2024,12,6]]},"reference":[{"author":"Centers for Disease Control and Prevention","key":"2025071507132244800_dgae848-B1"},{"issue":"7","key":"2025071507132244800_dgae848-B2","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1111\/pedi.13406","article-title":"ISPAD clinical practice consensus guidelines 2022: diabetic ketoacidosis and hyperglycemic hyperosmolar state","volume":"23","author":"Glaser","year":"2022","journal-title":"Pediatr Diabetes"},{"issue":"3","key":"2025071507132244800_dgae848-B3","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1016\/j.jpeds.2013.02.005","article-title":"Low morbidity and mortality in children with diabetic ketoacidosis treated with isotonic fluids","volume":"163","author":"White","year":"2013","journal-title":"J Pediatr"},{"issue":"7","key":"2025071507132244800_dgae848-B4","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1097\/PCC.0b013e3182975cab","article-title":"Increasing use of hypertonic saline over mannitol in the treatment of symptomatic cerebral edema in pediatric diabetic ketoacidosis: an 11-year retrospective analysis of mortality","volume":"14","author":"Decourcey","year":"2013","journal-title":"Pediatr Crit Care Med"},{"issue":"24","key":"2025071507132244800_dgae848-B5","doi-asserted-by":"crossref","first-page":"2275","DOI":"10.1056\/NEJMoa1716816","article-title":"Clinical trial of fluid infusion rates for pediatric diabetic ketoacidosis","volume":"378","author":"Kuppermann","year":"2018","journal-title":"N Engl J Med"},{"issue":"2","key":"2025071507132244800_dgae848-B6","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1016\/j.jpeds.2009.11.057","article-title":"Hyperglycemic hyperosmolar state: an emerging pediatric problem","volume":"156","author":"Rosenbloom","year":"2010","journal-title":"J Pediatr"},{"issue":"8","key":"2025071507132244800_dgae848-B7","doi-asserted-by":"crossref","first-page":"726","DOI":"10.4158\/EP-2018-0120","article-title":"Pediatric diabetic ketoacidosis with hyperosmolarity: clinical characteristics and outcomes","volume":"24","author":"Agrawal","year":"2018","journal-title":"Endocr Pract"},{"key":"2025071507132244800_dgae848-B8","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.jpeds.2022.08.010","article-title":"The coronavirus disease 2019 pandemic is associated with a substantial rise in frequency and severity of presentation of youth-onset type 2 diabetes","volume":"251","author":"Magge","year":"2022","journal-title":"J Pediatr"},{"issue":"(5)","key":"2025071507132244800_dgae848-B9","first-page":"e1609","article-title":"Risk factors for adverse outcomes in children with diabetic ketoacidosis","volume":"110","author":"Yousif","year":"2024","journal-title":"J Clin Endocrinol Metab"},{"issue":"1","key":"2025071507132244800_dgae848-B10","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1111\/pedi.12795","article-title":"Fluid treatment for children with diabetic ketoacidosis: how do the results of the pediatric emergency care applied research network fluid therapies under investigation in diabetic ketoacidosis (FLUID) trial change our perspective?","volume":"20","author":"Glaser","year":"2019","journal-title":"Pediatr Diabetes"},{"issue":"5","key":"2025071507132244800_dgae848-B11","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1542\/peds.19.5.823","article-title":"The maintenance need for water in parenteral fluid therapy","volume":"19","author":"Holliday","year":"1957","journal-title":"Pediatrics"},{"issue":"8","key":"2025071507132244800_dgae848-B12","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1001\/archpediatrics.2009.106","article-title":"Hyponatremia in pediatric diabetic ketoacidosis: reevaluating the correction factor for hyperglycemia","volume":"163","author":"Oh","year":"2009","journal-title":"Arch Pediatr Adolesc Med"},{"key":"2025071507132244800_dgae848-B13"},{"issue":"6","key":"2025071507132244800_dgae848-B14","doi-asserted-by":"crossref","first-page":"e20183083","DOI":"10.1542\/peds.2018-3083","article-title":"Clinical practice guideline: maintenance intravenous fluids in children","volume":"142","author":"Feld","year":"2018","journal-title":"Pediatrics"},{"issue":"12","key":"2025071507132244800_dgae848-B15","doi-asserted-by":"crossref","first-page":"1691","DOI":"10.1007\/s00134-022-06882-z","article-title":"ESPNIC clinical practice guidelines: intravenous maintenance fluid therapy in acute and critically ill children- a systematic review and meta-analysis","volume":"48","author":"Brossier","year":"2022","journal-title":"Intensive Care Med"},{"issue":"3","key":"2025071507132244800_dgae848-B16","doi-asserted-by":"crossref","first-page":"432","DOI":"10.2215\/CJN.12141018","article-title":"Hypernatremia","volume":"14","author":"Qian","year":"2019","journal-title":"Clin J Am Soc Nephrol"},{"issue":"feb14 1","key":"2025071507132244800_dgae848-B17","doi-asserted-by":"crossref","first-page":"g1532","DOI":"10.1136\/bmj.g1532","article-title":"Nested case-control studies: advantages and disadvantages","volume":"348","author":"Sedgwick","year":"2014","journal-title":"BMJ"},{"issue":"3","key":"2025071507132244800_dgae848-B18","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1542\/peds.108.3.735","article-title":"Improving management of diabetic ketoacidosis in children","volume":"108","author":"Felner","year":"2001","journal-title":"Pediatrics"}],"container-title":["The Journal of Clinical Endocrinology &amp; Metabolism"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jcem\/advance-article-pdf\/doi\/10.1210\/clinem\/dgae848\/60972405\/dgae848.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jcem\/article-pdf\/110\/8\/e2517\/60972405\/dgae848.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jcem\/article-pdf\/110\/8\/e2517\/60972405\/dgae848.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T11:14:14Z","timestamp":1752578054000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jcem\/article\/110\/8\/e2517\/7918367"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,6]]},"references-count":18,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2024,12,6]]},"published-print":{"date-parts":[[2025,7,15]]}},"URL":"https:\/\/doi.org\/10.1210\/clinem\/dgae848","relation":{},"ISSN":["0021-972X","1945-7197"],"issn-type":[{"type":"print","value":"0021-972X"},{"type":"electronic","value":"1945-7197"}],"subject":[],"published-other":{"date-parts":[[2025,8]]},"published":{"date-parts":[[2024,12,6]]}}}