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Management of Diabetic Ketoacidosis in Children and Adolescents with Type 1 Diabetes Mellitus

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Abstract

Diabetic ketoacidosis (DKA) is the end result of insulin deficiency in type 1 diabetes mellitus (T1D). Loss of insulin production leads to profound catabolism with increased gluconeogenesis, glycogenolysis, lipolysis, and muscle proteolysis causing hyperglycemia and osmotic diuresis. High levels of counter-regulatory hormones lead to enhanced ketogenesis and the release of ‘ketone bodies’ into the circulation, which dissociate to release hydrogen ions and cause an overwhelming acidosis. Dehydration, hyperglycemia, and ketoacidosis are the hallmarks of this condition. Treatment is effective repletion of insulin, fluids and electrolytes. Newer approaches to early diagnosis, treatment, and prevention may diminish the risk of DKA and its childhood complications including cerebral edema. However, the potential for some technical and pharmacologic advances in the management of T1D to increase DKA events must be recognized.

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Author notes

  1. Luz Castellanos and Marwa Tuffaha Co-first-authors.

Authors and Affiliations

  1. Division of Pediatric Endocrinology and Pediatric Diabetes Center, Massachusetts General Hospital, 175 Cambridge Street, 5th Floor, Boston, MA, 02114, USA

    Luz Castellanos, Marwa Tuffaha, Dorit Koren & Lynne L. Levitsky

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  1. Luz Castellanos
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  2. Marwa Tuffaha
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  3. Dorit Koren
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  4. Lynne L. Levitsky
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Correspondence to Lynne L. Levitsky.

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No outside funding was used in the preparation of this review article.

Conflict of interest

Dr. Levitsky is a consultant to Eli Lilly on a study of a diabetes drug and has been a consultant to Novo Nordisk on a diabetes drug trial. The remaining authors have no potential conflicts of interest to declare.

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Castellanos, L., Tuffaha, M., Koren, D. et al. Management of Diabetic Ketoacidosis in Children and Adolescents with Type 1 Diabetes Mellitus. Pediatr Drugs 22, 357–367 (2020). https://doi.org/10.1007/s40272-020-00397-0

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