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Rosenbloom AL. The management of diabetic ketoacidosis in children. Diabetes Ther. 2011;1(2):103-20doi: 10.1007/s13300-010-0008-2.
Rosenbloom, A. L. (2010). The management of diabetic ketoacidosis in children. Diabetes therapy : research, treatment and education of diabetes and related disorders, 1(2), 103-20. https://doi.org/10.1007/s13300-010-0008-2
Rosenbloom, Arlan L. "The management of diabetic ketoacidosis in children." Diabetes therapy : research, treatment and education of diabetes and related disorders vol. 1,2 (2010): 103-20. doi: https://doi.org/10.1007/s13300-010-0008-2
Rosenbloom AL. The management of diabetic ketoacidosis in children. Diabetes Ther. 2010 Dec;1(2):103-20. doi: 10.1007/s13300-010-0008-2. Epub 2011 Jan 12. PMID: 22127748; PMCID: PMC3138479.
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Diabetes Ther. 2010 Dec;1(2):103-20. doi: 10.1007/s13300-010-0008-2. Epub 2011 Jan 12.

The management of diabetic ketoacidosis in children.

Diabetes therapy : research, treatment and education of diabetes and related disorders

Arlan L Rosenbloom

Affiliations

  1. Division of Endocrinology, Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida, USA, [email protected].

PMID: 22127748 PMCID: PMC3138479 DOI: 10.1007/s13300-010-0008-2

Abstract

The object of this review is to provide the definitions, frequency, risk factors, pathophysiology, diagnostic considerations, and management recommendations for diabetic ketoacidosis (DKA) in children and adolescents, and to convey current knowledge of the causes of permanent disability or mortality from complications of DKA or its management, particularly the most common complication, cerebral edema (CE). DKA frequency at the time of diagnosis of pediatric diabetes is 10%-70%, varying with the availability of healthcare and the incidence of type 1 diabetes (T1D) in the community. Recurrent DKA rates are also dependent on medical services and socioeconomic circumstances. Management should be in centers with experience and where vital signs, neurologic status, and biochemistry can be monitored with sufficient frequency to prevent complications or, in the case of CE, to intervene rapidly with mannitol or hypertonic saline infusion. Fluid infusion should precede insulin administration (0.1 U/kg/h) by 1-2 hours; an initial bolus of 10-20 mL/kg 0.9% saline is followed by 0.45% saline calculated to supply maintenance and replace 5%-10% dehydration. Potassium (K) must be replaced early and sufficiently. Bicarbonate administration is contraindicated. The prevention of DKA at onset of diabetes requires an informed community and high index of suspicion; prevention of recurrent DKA, which is almost always due to insulin omission, necessitates a committed team effort.

Keywords: adolescents; cerebral edema; children; complications; diabetic ketoacidosis; fluid replacement; hypokalemia; management; prevention; recurrent DKA

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