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 Vol. 29 No. 12, December 2008
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(Pediatrics in Review. 2008;29:431-436.)
© 2008 American Academy of Pediatrics

Management of Diabetic Ketoacidosis in Children and Adolescents


David W. Cooke, MD*
Leslie Plotnick, MD{dagger}
 * Associate Professor, Department of Pediatrics, Division of Pediatric Endocrinology, Johns Hopkins University School of Medicine, Baltimore, Md
{dagger} Professor, Department of Pediatrics, Division of Pediatric Endocrinology, Johns Hopkins University School of Medicine, Baltimore, Md

The first 300 words of the full text of this article appear below.


   Objectives
 
After completing this article, readers should be able to:

  1. Describe the typical presentation of diabetic ketoacidosis in children.
  2. Discuss the treatment of diabetic ketoacidosis.
  3. Explain the potential complications of diabetic ketoacidosis that can occur during treatment.


   Introduction
 
Diabetic ketoacidosis (DKA) represents a profound insulin-deficient state characterized by hyperglycemia (>200 mg/dL [11.1 mmol/L]) and acidosis (serum pH <7.3, bicarbonate <15 mEq/L [15 mmol/L]), along with evidence of an accumulation of ketoacids in the blood (measurable serum or urine ketones, increased anion gap). Dehydration, electrolyte loss, and hyperosmolarity contribute to the presentation and potential complications. DKA is the most common cause of death in children who have type 1 diabetes. Therefore, the best treatment of DKA is prevention through early recognition and diagnosis of diabetes in a child who has polydipsia and polyuria and through careful attention to the treatment of children who have known diabetes, particularly during illnesses.


   Presentation
 
Patients who have DKA generally present with nausea and vomiting. In individuals who have no previous diagnosis of diabetes mellitus, a preceding history of polyuria, polydipsia, and weight loss usually can be elicited. With significant ketosis, patients may have a fruity breath. As the DKA becomes more severe, patients develop lethargy due to the acidosis and hyperosmolarity; in severe DKA, they may present with coma. Acidosis and ketosis cause an ileus that can lead to abdominal pain severe enough to raise concern for an acutely inflamed abdomen, and the elevation of the stress hormones epinephrine and cortisol in DKA can lead to an elevation in the white blood cell count, suggesting infection. Thus, leukocytosis during DKA is not a reliable indicator of infection. On the other hand, infection can be a precipitant of DKA. Therefore, careful evaluation is important, with early treatment of any infection.

The most common cause for DKA in a patient . . . [Full Text of this Article]






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