Introduction

Diabetic ketoacidosis (DKA) is one of the most fre­quent and potentially severe metabolic emergencies in pe­diatrics, with high prevalence among children with type 1 diabetes. Treatment is based on careful fluid replacement and intravenous insulin administration, in which precise dosing is essential to avoid hypoglycemia and insufficient response to initial therapy.

In clinical practice, insulin has been shown to under­go a physicochemical phenomenon known as adsorption, through which drug molecules adhere to the surfaces of the materials used for its dilution and administration. This interaction can significantly reduce the concentration of insulin effectively received by the patient, a particularly relevant issue in pediatrics, where small dosing variations can have a substantial clinical impact.

This article reviews the available evidence on insulin adsorption to different materials and highlights the rele­vance of this phenomenon in the management of diabetic ketoacidosis in pediatric emergency settings.

Development

Insulin is a protein with a complex structure, whose sta­bility and availability can be compromised by physical and chemical factors. One mechanism that affects its bioavail­ability during intravenous administration is adsorption, a process by which drug molecules adhere to the internal sur­faces of devices used for dilution and perfusion⁽¹⁾.

Studies have shown that materials such as polyvi­nyl chloride (PVC) and polyethylene (PE) have a high adsorption capacity, especially during the initial minutes of contact, which may translate into a significant reduction in the administered dose. Losses of up to 24% of insulin have been observed in the first 30 minutes in PVC systems, whereas systems made of polyurethane (PUR) or glass show significantly lower losses^(2,3). 

From a nursing perspective, double priming of the in­fusion system with the diluted insulin solution has been identified as an effective procedure to reduce drug ad­sorption to system materials^(4,5). This procedure consists of filling the infusion system twice consecutively before initiating perfusion to the patient, ensuring saturation of surfaces and reducing the initial loss of active substance. Double priming is performed using the same prepared in­sulin solution. This practice is recommended when using materials with high adsorption such as PVC or PE.

Discussion

The phenomenon of insulin adsorption to plastic ma­terials is a subtle yet clinically meaningful challenge in the management of pediatric diabetic ketoacidosis. Although DKA treatment is protocolized, the choice of infusion ma­terial and preparation procedures may substantially alter the effective dose administered to the patient^(1,2).

In this context, nursing staff play a crucial role not only in executing medical indications but also in prevent­ing errors related to the use of inadequate materials. The use of double priming is an accessible, safe, and effective measure that can significantly reduce the initial loss of insulin within the infusion system.

Implementing strategies such as double priming and evaluating the type of material used requires an integrated care perspective that includes both technical and scientific aspects, reinforcing the role of nursing professionals as key contributors to quality of care in critical contexts.

Conclusion

Precision in intravenous insulin administration for the treatment of pediatric diabetic ketoacidosis depends not only on dose calculation but also on understanding and correctly using the materials involved in its preparation and administration. Adsorption to materials such as PVC or PE can compromise therapeutic effectiveness.

From a nursing practice standpoint, implementing double priming of the infusion system is a safe, effective, and low-cost strategy to minimize drug loss. Appropriate material selection, use of double priming, and adherence to updated protocols are essential measures to ensure treatment efficacy.

Funding

This research did not receive any specific grant from public, commercial, or nonprofit funding agencies.

Conflict of interest

The author declares no conflicts of interest.

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