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Diabetes Ther (2010) 1(2):103-120. DOI 10.1007/s13300-010-0008-2


The Management of Diabetic Ketoacidosis in Children
Arlan L. Rosenbloom

Received: October 28, 2010 / Publishedonline: January 12, 2011 © The Author(s) 2011. This article is published with open access at Springerlink.com

0008-2 2

The object of this review is to provide the definitions,frequency, risk factors, pathophysiology, diagnostic considerations, and management recommendations for diabetic ketoacidosis (DKA) in children and adolescents, and to convey current knowledge of the causes ofpermanent disability or mortality from complications of DKA or its management, particularly the most common complication, cerebral edema (CE). DKA frequency at the time of diagnosis of pediatricdiabetes is 10%-70%, varying with the availability of healthcare and the incidence of type 1 diabetes (T1D) in the community. Recurrent DKA rates are also dependent on medical services and socioeconomiccircumstances. Management should be in centers with experience and where vital signs, neurologic status, and biochemistry can be monitored with sufficient frequency to

prevent complications or, inthe case of CE, to intervene rapidly with mannitol or hypertonic saline infusion. Fluid infusion should precede insulin administration (0.1 U/kg/h) by 1-2 hours; an initial bolus of 10-20 mL/kg 0.9%saline is followed by 0.45% saline calculated to supply maintenance and replace 5%-10% dehydration. Potassium (K) must be replaced early and sufficiently. Bicarbonate administration is contraindicated.The prevention of DKA at onset of diabetes requires an informed community and high index of suspicion; prevention of recurrent DKA, which is almost always due to insulin omission, necessitates acommitted team effort. Keywords: adolescents; cerebral edema; children; complications; diabetic ketoacidosis; fluid replacement; hypokalemia; management; prevention; recurrent DKA

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