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Management of Diabetic Ketoacidosis in Children and Adolescents

  • Therapy In Practice
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Abstract

Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus. While it can occur in all types of diabetes mellitus, it is seen most often in patients with type 1 diabetes, either at presentation or as a result of non-compliance with medical therapy. DKA is characterized by hyperglycemia, acidosis, dehydration, and electrolyte abnormalities, which result from a deficiency of insulin and an excess of counter-regulatory hormones.

Therapy is aimed at repleting fluids, and correcting acidosis and electrolyte disturbances by administration of intravenous fluid and intravenous insulin. Rapid correction should be avoided as it may result in untoward effects, including cerebral edema. Frequent monitoring of neurologic status and metabolic parameters aids in avoidance or early detection of complications. While much is still not understood about the most serious complication, cerebral edema, recent studies suggest that its development may be tied to a loss of cerebral autoregulation and a vasogenic mechanism of edema formation. Treatment of cerebral edema includes fluid restriction and administration of mannitol. Once DKA has resolved, subcutaneous insulin is initiated with careful consideration of its pharmacokinetics to avoid a period of insulin deficiency and metabolic decompensation.

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Notes

  1. Corrected serum sodium = measured sodium + (1.6 × glucose [mg/dL] − 100)/100.

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Acknowledgments

No sources of funding were used to assist in the preparation of this review. Lynne L. Levitsky has received consulting fees and honoraria from sanofi-aventis. Nicole A. Sherry has no conflicts of interest that are directly relevant to the content of this review.

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  1. Pediatric Endocrine Unit, Massachusetts General Hospital for Children, Harvard University, 175 Cambridge Street, 5th Floor/Room 537, Boston, Massachusetts, 02114, USA

    Nicole A. Sherry & Lynne L. Levitsky

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  1. Nicole A. Sherry
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Correspondence to Nicole A. Sherry.

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Sherry, N.A., Levitsky, L.L. Management of Diabetic Ketoacidosis in Children and Adolescents. Pediatr-Drugs 10, 209–215 (2008). https://doi.org/10.2165/00148581-200810040-00002

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