Children with Diabetic Ketoacidosis Treated with Restricted Fluid Regime in Intensive Care: Risk of Acute Kidney Injury is not Increased and Resolves
Why this work is in the frame
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Bibliographic record
Abstract
Background: Children admitted to intensive care with diabetic ketoacidosis are at risk of acute kidney injury. Recent UK guidelines recommends against restricted fluid provision due to a theoretical risk of kidney injury. To date no data has been published that documents this risk in an intensive care cohort. Aims: To describe the natural history of acute kidney injury in patients admitted with diabetic ketoacidosis in whom a restrictive fluid regime was provided. Methods: Retrospective analysis, within a UK Pediatric Intensive Care Unit. Between January 2011 and December 2020 219 patients were referred to the South Thames Retrieval Service with Diabetic Ketoacidosis, of whom 52 were admitted to Evelina PIC. 49 of these records were complete and used for analysis of acute kidney injury stage using Kidney Disease: Improving Global Outcomes criteria measured by serial creatinine. Clinical outcome at discharge from Pediatric Intensive Care was also recorded. Results: 19 out of 49 (38%) patients had acute kidney injury (17 present on admission to pediatric intensive care). Three patients required renal replacement therapy though all of them went on to re-establish their baseline renal function. This compares favourably to published data documenting an acute kidney injury incidence of 43-64% in general paediatric and pediatric intensive care cohorts. Conclusion: In the context of diabetic ketoacidosis, use of a restrictive fluid regime was not associated with higher levels of acute kidney injury than other studies and renal function recovery was observed in all patients followed up.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it