Fluid Management of Children Who Have Diabetic Ketoacidosis
Editors: Kenneth B. Roberts, MD.
Diabetic ketoacidosis (DKA) is a potentially life-threatening metabolic state that complicates insulin-dependent diabetes mellitus. In the absence of sufficient insulin, glucose is unable to enter cells, and the concentration in plasma increases. When the renal threshold is exceeded (generally at a concentration of about 180 mg/dL), an osmotic diuresis occurs, leading to dehydration. Additional water is lost through hyperventilation (an attempt to compensate for metabolic acidosis), vomiting, and in some cases, diarrhea. Water is drawn from the intracellular space to the plasma to equilibrate the tonicity of the two compartments, bolstering the circulation but producing further intracellular dehydration. Fat is metabolized for fuel because glucose without adequate insulin is not available to cells; beta-hydroxybutyric acid and acetoacetic acid are produced in the process and contribute to acidosis.
