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This Article Full Text Full Text (PDF) Take the CME quiz: Vol. 29 No. 12, December 2008 Rapid Responses: Submit a response Alert me when this article is cited Alert me when Rapid Responses are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Cooke, D. W. Articles by Plotnick, L. Search for Related Content PubMed Articles by Cooke, D. W. Articles by Plotnick, L. Related Collections Endocrine Disorders Metabolic Disorders Fluid and Electrolyte Metabolism Emergency Care Critical Care Social Bookmarking                         What's this?

Management of Diabetic Ketoacidosis in Children and Adolescents

David W. Cooke, MD^*
Leslie Plotnick, MD

^* Associate Professor, Department of Pediatrics, Division of Pediatric Endocrinology, Johns Hopkins University School of Medicine, Baltimore, Md
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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