Resolution of acidosis is monitored closely in diabetic ketoacidosis following which intravenous (IV) insulin is transited to subcutaneous (SC) insulin. This study evaluated if measurement of serum bicarbonate (target ³15 mmol/L) was better than venous pH (³7.3) to shorten duration of insulin infusion and pediatric intensive care unit (PICU) therapies. Retrospective review of 274 case records of children was performed. Approximately equal number had transited from IV to SC insulin based on serum bicarbonate (n=132) and venous pH (n=142). The duration of insulin infusion and PICU stay were significantly shorter in bicarbonate group. The adverse events recorded between both groups remained similar.

Hydrocortisone remains the mainstay of therapy in patients with adrenal insufficiency. Sick children with adrenal insufficiency require hydrocortisone to be administered through nasogastric (NG) tube, the accuracy of which was investigated in this study. Investigators of this in vitro study compared hydrocortisone delivery through NG tubes in three forms – liquid suspension, crushed tablets mixed with water and granules suspended in water. Doses of 0.5 mg and 2 mg in 2mL water followed by 2-5 mL flush were tested in NG tubes of 6, 8, 10 and 12 Fr. The drug delivery was collected from the lower end of the NG tube after a waiting time of three minutes as set of six repeated measurements. NG tubes were flushed again if they visibly contained any drug granules along their walls. The quantity of hydrocortisone was measured by liquid chromatographytandem mass spectrometry (LCMS/MS) method. Results showed lower mean concentration of hydrocortisone (for 0.5 mg and 2 mg) at nasal end when given as liquid suspension (57% and 58%), crushed tablets (46% and 30%) and granules (78% and 71%). The drug concentration increased significantly after flushing the syringe at the nasal end. The drug delivery of liquid form of 0.5 mg and 2 mg dose varied from 65-92% and 61-65%, respectively at the gastric end. The delivery of crushed tablets of 0.5 mg and 2 mg were 59% to 174% and 40-96%, respectively (maximum with 12Fr NG tube). Similarly, the drug concentration for granular preparation 0.5 mg and 2 mg were 66-83% and 61-92%, respectively (maximum with 12Fr NG tube). The study highlights the lower dose recovery of hydrocortisone through NG tube unless flushed during administration. The greatest variability was seen with the use of crushed tablets and least with granules. A 12Fr NG delivered the maximum concentration when used as crushed tablet or granule, unlike liquid suspension that was unaffected by tube size.