Abuzzahab, M. Jennifer

OBJECTIVES The 2-bag intravenous (IV) fluid system for diabetic ketoacidosis (DKA) has been associated with shorter duration of insulin and faster resolution of acidosis. Our aims were to increase the use of 2-bag IV fluids among children with medium- or high-risk DKA treated at 2 tertiary care pediatric hospitals and to increase the proportion of children who receive timely administration of fluid and insulin treatments. METHODS We conducted a quality improvement initiative using data from January 1, 2014, to December 31, 2021, among patients 21 years or younger with medium- or high-risk DKA. The study spanned pre- and post-initiative periods and a stability period. Our interventions included development of a clinical practice guideline, education, and electronic medical record updates. Statistical process control methods were used to evaluate outcome changes. RESULTS We identified 876 eligible encounters. Age, sex, and the proportion of children with medium- or high-risk DKA were similar across study periods. A higher proportion of non-Hispanic Black children was observed in the stability period (26.3%) than the pre- (17.7%) and post-initiative (18.2%) periods. We observed an increase in 2-bag IV fluid use from an average of 41.3% to 77.7%. We did not observe changes in time to isotonic fluid bolus, continuous insulin, or 2-bag IV fluids. There was no change in hypoglycemic events. CONCLUSION We increased the proportion of children with medium- or high-risk DKA treated with 2-bag IV fluids through a combination of interventions, including implementation and refinement of a clinical guideline, creation of a nurse algorithm, and nursing education.

ObjectiveTo assess the safety and efficacy of short‐term meal replacement therapy followed by topiramate for body mass index (BMI) reduction in adolescents with severe obesity.MethodsAdolescents (ages 12–18 years) with severe obesity (BMI ≥1.2 times the 95th percentile or BMI ≥35 kg/m2) were recruited for this double‐blind, randomized, placebo‐controlled trial. Participants completed 4 weeks of meal replacement therapy followed by randomization (1:1) to either 24 weeks of topiramate 75 mg/day or placebo. Mean changes were compared between groups.ResultsThirty adolescents (mean age 15.2 ± 1.7 years, mean BMI 40.3 ± 4.6 kg/m2) completed the meal replacement phase and were randomized; 21 completed the study. The difference in mean percent change in BMI between the topiramate and placebo groups was not significant (−1.9%; 95% CI: −5.2% to +1.5%; P = 0.291). Significant improvements in visceral fat and very‐low‐density lipoprotein cholesterol were observed in the topiramate compared with the placebo group. There were no concerning changes in neurocognitive function or bone health.ConclusionsIn this pilot study, 4 weeks of meal replacement therapy followed by 24 weeks of low‐dose topiramate compared with meal replacement therapy alone did not result in significant BMI reduction for adolescents with severe obesity.