Treatment and complications of diabetic ketoacidosis in children and adolescents
- George S Jeha, MD
George S Jeha, MD
- Assistant Professor of Pediatrics
- Baylor College of Medicine
- Morey W Haymond, MD
Morey W Haymond, MD
- Professor of Pediatric Nutrition
- Baylor College of Medicine
- Section Editors
- Joseph I Wolfsdorf, MB, BCh
Joseph I Wolfsdorf, MB, BCh
- Section Editor — Pediatric Endocrinology
- Professor of Pediatrics
- Harvard Medical School
- Adrienne G Randolph, MD, MSc
Adrienne G Randolph, MD, MSc
- Section Editor — Pediatric Critical Care Medicine
- Professor of Anaesthesia and Pediatrics
- Harvard Medical School
Diabetic ketoacidosis (DKA) is the leading cause of morbidity and mortality in children with type 1 diabetes mellitus (T1DM), with a case fatality rate ranging from 0.15 percent to 0.31 percent [1-3]. DKA also can occur in children with type 2 DM (T2DM); this presentation is most common among youth of African-American descent [4-8]. (See "Classification of diabetes mellitus and genetic diabetic syndromes".)
The management of DKA in children will be reviewed here (table 1). There is limited experience in the management and outcomes of DKA in children with T2DM, although the same principles should apply. The clinical manifestations and diagnosis of DKA in children and the pathogenesis of DKA are discussed elsewhere. (See "Clinical features and diagnosis of diabetic ketoacidosis in children and adolescents" and "Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Epidemiology and pathogenesis".)
●Diabetic ketoacidosis – A consensus statement from the International Society for Pediatric and Adolescent Diabetes (ISPAD) in 2014 defined the following biochemical criteria for the diagnosis of diabetic ketoacidosis (DKA) :
•Hyperglycemia – blood glucose of >200 mg/dL (11 mmol/L) AND
•Metabolic acidosis – venous pH <7.3 or a plasma bicarbonate <15 mEq/L (15 mmol/L) AND
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- INITIAL RAPID ASSESSMENT
- Clinical assessment
- Laboratory testing
- Assessment of severity
- Moderate and severe DKA
- - Dehydration
- Initial volume expansion
- Subsequent fluid administration
- - Hyperglycemia
- - Electrolyte and acid-base disturbances
- Serum sodium
- Serum potassium
- Metabolic acidosis
- - Monitoring
- - Discontinuing the insulin infusion
- Mild DKA
- COMPLICATIONS AND MORTALITY
- Cerebral edema
- Cognitive impairment
- Venous thrombosis
- Cardiac arrhythmia
- Pancreatic enzyme elevations
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS